ABC (Abstain, be faithful, use a condom): Does the Message Work?

[ILLUSTRATION OMITTED]

This article describes an exploratory study that was carried out with focus groups as part of the project on STI/AIDS Prevention among Men and Women conducted by the women's health group Taller Abierto, based in Cali, Colombia. This project was carried out with the support of the Dutch international development organization CORDAID. The research team included Claudia Ximena Palta, Gelber Sanchez, Maria Elena Unigarro, Susana Pinacue and Wili Quintero. For more information, contact the researchers at [e-mail].

Overview

Although HIV/AIDS is a problem that affects all of humanity, it has been particularly hard on those living in the poorest regions of the world. According to UNAIDS, as of December 31, 2004, a total of 39.4 million people worldwide were living with HIV. Women account for close to half of this number, and 2.2 million are boys and girls under 15 years of age. This year alone, 4.9 million people were infected with the virus (640,000 of them under age 15), and 3.1 million died from AIDS (510,000 under age 15) (UNAIDS, 2004b).

In Latin America at the end of 2004, 1.7 million people were living with HIV, including 610,000 women (36%). That year also saw 240,000 new cases of HIV infection and 95,000 deaths due to AIDS in the region (UNAIDS, 2004b).

In Colombia, 40,072 cases had been reported as of September 2003 (Estrada, 2004:1) though the real figure is estimated to be anywhere from 192,000 to 450,000, taking into account cases unreported to health authorities (Velandia, 2004:80).

In the Colombian city of Cali, a total of 1,319 cases were reported in 2003. (1) These reported cases included men and women from all age and socio-cultural groups and from every sector of the city (Estrada, 2004:4). Half of these cases were people under 35 years of age, and the highest rate of infection was among 25 to 39-year-olds (47%). Although men accounted for 68% of those infected, in Cali as in the rest of the world, the number of women being infected is growing steadily as reflected in the increase in heterosexual transmission (44% of new cases in which the sexual orientation of the infected person is known). (2) Studies also have identified other risk factors for acquiring HIV: a history of sexually transmitted infections (STIs); consuming alcohol and/or psychoactive drugs; engaging in the sex trade; being in a correctional facility; sexual violence.

The first case of HIV/AIDS in Jamundi--a town of about 63,000 in southwestern Colombia, 24 kilometers from Cali--was reported in 1998. To date, the Secretaria de Salud Municipal (Municipal Health Office) has reported a total of 50 cases: 40% of those infected are 25 to 34 years old, 18% are 40 to 49, 16% in the 15 to 19 age group and 8% are 35 to 39 years old. Men represent 52% of all reported cases of HIV, and women 48%. Most (60%) cases have been detected in the urban area, and 14 (28%) of those diagnosed with AIDS have died (Secretaria de Salud de Jamundi, 2004).

There are no studies on the number of HIV-positive individuals in indigenous communities. General statistics for rural zones are not broken down into indigenous and campesino groups. Thus, "in regard to the problem of STIs, there is little information; although a number of ethnographic studies have been conducted in a number of the country's indigenous communities, none has sought to report on sexual conduct and behavior and their impact on the health of these communities" (UNAIDS/Colombia, Ministerio de Salud, 1999:13).

In confronting HIV/AIDS worldwide, there are often attempts to promote sexual abstinence, stable partnerships (monogamy) and condom use as effective mechanisms to prevent infection. This has been called the ABC message: "Abstain, Be faithful, use a Condom" (Anderson, 1998:17-26).

Taken in a literal, absolute and decontextualized manner, the ABC proposal seems irrefutable. Obviously, men and women who choose not to have sex or who establish mutually monogamous relationships with a single partner (without being infected beforehand) or who use a condom in all sexual relations will greatly decrease the likelihood of acquiring HIV.

[ILLUSTRATIONS OMITTED]

For the past 15 years, the ABC message has been disseminated across the globe and gradually has become common knowledge among large sectors of the population, who have incorporated it into their discourses related to sex. For example, in the recent "Estudio sobre Conocimiento, Actitudes y Practicas, CAP, de la sexualidad de la poblacion de Cali" (Study of Sexual Knowledge, Attitudes and Practices, KAP, among the Cali Population), 40% of women and men surveyed mentioned condoms, and 37% referred to a stable partner as suitable methods for preventing STIs and AIDS (Alcaldia de Santiago de Cali, et al., 2004: 21-35). Similar results were obtained from the latest Encuesta Nacional de Demografia y Salud (National Survey of Population and Health): in Cali, the three most common methods reported by women to avoid AIDS were condom use (69%), sexual abstinence (18%) and monogamy (37%) (PROFAMILIA, 2000:66-67). Similar responses were heard in workshops, talks, seminars and other sex education activities that we organized in local communities.

Of course, this is all at the level of discourse. When the focus is on attitudes and practices, the results change: In Cali, for example, 44% of men between 15 and 35 years of age admitted to having sex with more than one partner in the previous 12 months (compared to 17% of women), and 54% of men in this same age group said they did not use a condom (among women, this figure rose to 67%) (Alcaldia de Santiago de Cali, et al., 2004). Only 6% of the women said they used condoms when having sex with their partners, 21% used condoms with a long-term partner, and only 11% used condoms with all sex partners (PROFAMILIA, 2000).

These figures demonstrate that "information and knowledge are not enough," (UNAIDS, 2004b) and that the broad dissemination of the ABC message has not put a stop to or decreased the propagation of HIV/ AIDS. Indeed, the disease is spreading steadily, from 35 million infected worldwide in 2003 to 39.4 million in 2004; the 1.5 million infected in Latin America in 2002 had grown to 1.7 million by 2004 (UNAIDS, 2004b).

This disjuncture between the information that specialized entities promote, what the public appropriates into its discourse and how people really act points to the need to analyze the ABC message, to look more closely at what women and men, young adults and adolescents are understanding, assuming and interpreting with regard to sexual abstinence, monogamy and condom use.

In other words, the message needs to be contextualized and brought into the real world. It must be brought down to earth from the ideal realm and applied to men's and women's everyday lives. If it is to be more than just another slogan, we must also identify its true content, scope, potential usefulness, barriers and requirements (UNAIDS, 2004a).

[ILLUSTRATION OMITTED]

These questions guided the research carried out by the authors for four months (August to November 2004) in different working-class zones of Cali and Jamundi and in indigenous lands of the Cauca Department (Lopez Adentro, Caldono, Pueblo Nuevo, Jambalo). We used the technique of focal groups to gather information, the highlights of which are presented in this article.

This study is one of a series of actions undertaken on sexual and reproductive health by the Taller Abierto over the past 11 years. These efforts are focused on the prevention of problems related to sexuality: STIs/HIV/AIDS, unwanted pregnancy, sexual violence and other issues. The process is comprehensive in its focus, based on the view that sexuality is a fundamental part of being human, in which the undeniable biological fact of anatomical sexual difference interplays with a number of other facets of our existence: the physiological aspects of our genitalia and human reproduction, the psychology of individual development, the performance of socially defined male and female roles and the relationships constructed between the sexes through the exercise of power. This concept of sexuality includes erotic play, pleasure, cultural dimensions, interpersonal expressions of affection and ultimately procreation.

Therefore, when we speak of sexuality, we are referring not only to a biological phenomenon but also to a socio-cultural construction that is inscribed upon the bodies of men and women who, in turn, live in a particular spatial and historical context. In other words, sexuality is a human dimension that is permeated by cultural expressions and interpretations of current social, class, gender and ethnic relationships. Moreover, the practical application of this concept is intersected by gender and intercultural perspectives, which are inextricably linked.

Using a gender perspective as a way of analyzing male-female relationships enables us to identify the complex, historical and conflictive nature of such relationships. Such a perspective roots us in an historical and cultural place and time, revealing how masculinities and femininities are constructed and how they interact around the exercise of power. This social analysis allows us to analyze the differences between men and women with regard to power relations, socially assigned roles and spheres of action, which in turn enables us to promote the construction of new identities and relationships that are based on equality.

However, to fully understand human sexuality, in addition to a gender analysis it is crucial that we give due recognition to every culture, value their differences and question their homogenization. This produces what we understand as an intercultural perspective, the consideration of the diverse cultural contexts into which human beings are born, socialized and develop. Only when we begin by recognizing and valuing different ways of being can we encourage real transformations that enable positive changes in how we exercise our sexuality. An intercultural perspective makes it possible to address the different experiences of individuals and social groups without prejudice, promoting the interpretation, documentation and appraisal of the broad range of human beliefs and behaviors. This approach promotes self-analysis and reflection within cultures themselves that will help them to overcome the difficulties that arise.

Hence, gender and intercultural perspectives enable us to:

a) Identify the ideas, attitudes and behaviors of men, women and even communities with regard to sexuality, recognizing and accepting the diversity, weaknesses and potential for change in their historical development and in the foundations of their existence as individuals and social groups.

b) Propose specific alternatives tailored to gender and cultural contexts to avoid the risk of homogenization and cultural mandates.

c) Improve our comprehensive understanding of sexuality as a biological, psychological, social and cultural dimension of human beings.

d) Actively bring together women and men, adults and young people, to analyze their sexuality, identify their problems and propose alternatives in their own communicational codes, recovering their ancestral wisdom, experience and knowledge.

The Focus Groups (3)

Focus groups are a qualitative research technique for collecting information through semi-structured group interviews and the active observation of those conducting the study. They are organized around discussions of a specific topic (focalization) that emphasize participants' personal experiences. The researchers guide the discussion, encouraging verbal interaction that allows each participant to express his or her opinions openly, freely and spontaneously. The aim of such groups is to identify how participants perceive and process their experiences, what meanings they attach to them and how they share these meanings.

Our study examined HIV/AIDS prevention, looking at issues of vulnerability, sexual abstinence, stable partnerships and condom use.

In Cali, we conducted seven focal groups comprised of:

Group 1: Eight women between 12 and 33 years of age, mostly students, inhabitants of the working class neighborhood Las Orquideas in the Aguablanca District. The women were brought together by Lila Mujer, a woman's organization. Some of the women are living with HIV.

Group 2: Twenty-three women between the ages of 15 and 38, most of them young women under 18, indigenous immigrants to Cali working in domestic service. The women were invited by Taller Abierto and participate in programs run by this organization.

Group 3: Twenty adolescents (11 boys and nine girls) between 14 and 18 years of age, students in the "fast-track" education program ALPEINCO run by the Caja de Compensacion Familiar (COMFANDI, Family Compensation Board). About half of these participants also have jobs. Most are currently in grades 10 and 11.

Group 4: Twelve men from 16 to 18 years of age who have ties to the Fundacion Don Bosco (an organization that offers job training). The participants are inhabitants of the Aguablanca District and other poor sectors of Cali.

Group 5: Nine unmarried women between the ages of 16 and 18. The women also are inhabitants of the Aguablanca District and other poor sectors of Cali and associated with the Fundacion Don Bosco.

Group 6: Fourteen unmarried men between 19 and 22 years of age, who participate in the activities of the Fundacion Don Bosco and live in the Aguablanca District and other poor sectors of Cali.

Group 7: Twelve women between 19 and 35 years of age, four of them married, all associated with the Fundacion Don Bosco and inhabitants of the Aguablanca District or other poor sectors of Cali.

In Jamundi, we conducted three focal groups, which were composed as follows:

Group 1: Sixteen men from 15 to 19 years of age, students at the Institucion Educativa Central de Bachillerato Integrado de Jamundi, a public high school in a poor sector of Jamundi.

Group 2: Fifteen women between 14 and 17 years of age, students at the Institucion Educativa Central de Bachillerato Integrado de Jamundi.

Group 3: Nine people (eight women and one man) between 38 and 48 years of age from different professional backgrounds.

In the indigenous reserves, we chose to organize broad-based educational workshops rather than focus groups. The workshops provided opportunities to collect information relevant to the study in a variety of formats: games, talks, video-fora, group work, large meetings and conversations with individuals and small groups (three to five people) during breaks in the activities. The following list describes the participants of the workshops by where they were held:

1. Lopez Adentro Reserve: Thirty-six people, 21 boys and 15 girls, from 11 to 16 years of age. These were primary and secondary school students of the Colegio Dxi Phanden.

2. Lopez Adentro Reserve: Seven participants--teachers and community leaders--two men and five women between 27 and 46 years of age.

3. Jambalo Reserve: 125 participants in total, including 47 boys and 45 girls (8 to 14 years of age), seven adult men (27 to 53 years of age) and 26 adult women (26 to 54 years of age).

4. Pueblo Nuevo Reserve: Thirty-two secondary school students, 16 young women and 16 men from 13 to 20 years of age.

5. Caldono Reserve: Thirty-five participants, including 30 young adults (15 to 19 years of age) and five adults (20 to 50 years of age), secondary school students and inhabitants of the reserve.

The focal group activities were structured as follows:

Settling in and Introduction

The sessions began with a brief introduction on the topic of "STIs/ HIV/AIDS Prevention" with special care taken not to provide too much information at this stage that could influence the conversations to follow. The introduction aimed at fostering a climate of trust, respect, freedom and warmth, using brief references to courtship, school, dreams, television shows, soccer, families and other day-to-day topics introduced in a fresh, lively way by the research team.

Dialogue among Participants

In the dialogues, the participants expressed their opinions, experiences, knowledge and concerns freely. The research team guided the conversations using a series of questions that were introduced when the discussion wandered off topic, faltered or reached a dead end. Such interventions were made only when really necessary.

Enriching the Discussion

New questions were posed to broaden the discussion, clear up doubts, affirm beliefs and round out personal experiences. The research team then provided additional information to clarify and expand upon some of the issues that had arisen during earlier conversations. In some cases, this activity closed with a video forum on the topics discussed.

Transcription, Systematization and Analysis of the Information

The information obtained from the focal groups was transcribed to reconstruct what had occurred during each activity with an effort made to faithfully reproduce what was expressed and observed. The table on page 69 was created to cross reference different aspects considered in the study (vulnerability, sexual abstinence, stable partnership, condom use) with the factors of sex and age (those under and over 19 years of age).

[ILLUSTRATION OMITTED]

Finally, the information was analyzed in table format, and the researchers took note of similarities and differences by sex and/or age groups, repeated expressions and the most common responses, as well as other elements that emerged infrequently but were important because of their content, because of who expressed them--their degree of representativity and influence within the group--and the receptiveness of the group to those ideas.

The most common pedagogical strategy was oral exchange through open, respectful dialogue using common, everyday language in an environment of maximum trust to enable the free expression of ideas, knowledge, doubts and fears. Most of the conversations were taped and transcribed, and great care was taken to preserve their original form. The activities were held in places that are part of the participants' everyday lives: a neighbor's house, a school and community group headquarters. Individuals well known in the community--community leaders, teachers, public health staff--helped to prepare the activities and invited participants. Everyone who participated in the focal groups was aware of the discussion topic beforehand and attended voluntarily.

The organizations and locations of the focal groups were selected using the following criteria:

1. Participation in the processes promoted by Taller Abierto or previous contact with this organization through collaboration in its activities or projects.

2. Having one or more individuals willing to act as facilitators for the focal groups and processes that may emerge from them (these first two criteria are to ensure the continuity of the study so that it goes beyond an isolated, limited or sporadic effort and is incorporated into the groups and communities as a long-term strategy for the prevention of problems related to sexuality).

3. Having a space available that was suitable for holding focal groups, in other words, a welcoming space that fosters feelings of friendliness, free expression and trust to encourage the exchange of personal experiences.

4. Being able to ensure that participation in the focal groups was voluntary and informed, that participants received general information on the nature of the groups and were willing to participate.

5. Including men and women older and younger than 19 years of age as equitably as possible. These participants had not participated previously in formal sexual education activities and were inhabitants of popular neighborhoods of Cali and Jamundi and the indigenous lands of Lopez Adentro, Jambalo, Caldono and Pueblo Nuevo.

Reflections on the Focal Groups held in Cali and Jamundi

Vulnerability

Participants' opinions regarding their vulnerability to HIV/AIDS ranged from those who thought that everyone was equally at risk, depending on their sexual practices and the measures of protection used, to those who continued to think that vulnerability was related to membership in a certain social group, the misnamed "high-risk groups." This concept is entrenched with the unfortunate consequence that those who are not members of such groups feel that they are invulnerable to HIV/AIDS. In the Cali and Jamundi focal groups, for example, the " most vulnerable" groups identified were homosexuals and sex workers. This opinion was more prevalent among men of all ages and was expressed with a strong homophobic and moralistic bias.

Focal Group with Young Women

Who can become infected with HIV? (asked by one of the researchers).

"Both ..."

"I have heard that it is not proven, supposedly AIDS began with a homosexual, and homosexuals were the only ones to carry AIDS, but now I know that they are not the only ones who can get it."

"I say that homosexuals are the ones who most have AIDS."

"No ... I say that everyone can."

"No, that's not true about homosexuals, just because most cases of HIV have been reported among them doesn't mean that they are the only ones who have it today."

"No ... everyone can."

Focal Group with Young Women from Jamundi

"I think that not all homosexuals have AIDS. Anyways, we all run the same risk ..."

"I also think that it is not about being homosexual or about being promiscuous, but if you know that you are being careful you are not going to get any disease, you eliminate the risk."

Focal Group with Young Indigenous Immigrants in Cali

"For example, AIDS is transmitted through sex, blood transfusions, injections, accidents, by homosexuals."

All of you, when you are with your partner, has it ever occurred to you at any time that you could get this type of illness?

Silence ... laughter ...

Do you think that HIV/AIDS is only for prostitutes and homosexuals?

"No ..."

Who can get it?

"Anyone."

Focal Group with Young Men

How do you get AIDS?

"Through sex, through knives, stabbing, blood transfusions, tattoos."

"It's like, around our house there is a guy who got AIDS from a stab wound, because the knife was infected."

[ILLUSTRATION OMITTED]

"It is more of a homosexual thing. The environment among homosexuals is very rough, it's dirty, it's difficult. It's natural for them not to have stable partners and to be involved in prostitution."

"I also have heard that it is spread more among homosexuals and prostitutes."

"It is the same for all women. The same with the girl that is at home all week and works hard, but at the weekend goes out to 'party' and has sex, and it is easy for her to get it, too, and it is even easier for her to get it than sex workers, who protect themselves more these days."

Focal Group with Adult Men

How do you think people get STDs and AIDS?

"Through blood transfusions."

"Through bad girls or easy girls." Laughter. ...

The general perception behind the opinions and behavior expressed in the focal groups is that HIV/AIDS is something distant, something that can happen to others and not to those taking part in the groups. Adults, especially women, feel that young adults and adolescents are at higher risk than those who are more mature and that adults in long-term, monogamous partnerships who have formed a family are even less at risk.

"I'll tell you something," said one teacher, "it is one thing when I speak about my stable partnership, and another when I have to teach young people to protect themselves. In this sense, I don't practice what I preach. I tell them that it is good to protect yourselves because you are so young, just because you go out dancing with a boy you think you have to pay him back by sleeping with him."

"But with a stable partner, there is a lot of trust, and there is no need for condoms. If you know the person, there's no risk ..." (adult woman).

"I don't spend a lot of time talking about sexuality with my students, but I feel guilty only giving classes and not taking the time to talk about how to protect yourself. Yes, I feel guilty, but there are no opportunities for talking about the issue" (woman teacher).

[ILLUSTRATION OMITTED]

"At our age, we have almost no doubts about sex. As I said at the beginning: everything is fine. We have questions about raising our children, about how to begin to face the responsibility of our children's sex lives, to inform them well" (adult woman, approximately 45).

Young participants, especially young men, recognize that they run a risk by not protecting themselves properly at a given moment, but they continue to believe in "high-risk groups" and in the invulnerability or low risk of those who are not members of these groups. In other words, the idea of vulnerability--a warning light that should always be on--is lacking. According to the adult participants, it is the young people who are at risk, while the young people themselves believe that homosexuals and prostitutes are the most vulnerable. Few participants acknowledged the risks implied by having sex without proper protection.

Sexual Abstinence

Although women and men of all ages recognized that abstinence is the most effective way to avoid unwanted pregnancy, STIs and AIDS, they did not believe that they could choose to renounce having sex. This opinion usually was based on two arguments. The first was that human nature is stronger than willpower. It makes people instinctively seek an active sex life. "Abstinence is something illogical, [sex] is natural, how do you go against nature?" asked one young woman.

"It is a human need," stated one student from Jamundi, and another added, "Sex calls you, you can't avoid it." One young man stated that abstinence can be managed until an opportunity presents itself, but after that it is very difficult: "This idea of abstinence depends on the individual and the situation, because if the lady is really fine ..." An adult woman commented: "You try to encourage girls to not begin their sex lives at too young an age ... but their hormones ... who will guarantee that she will be able to deal with her hormones? ... and if the body rules ..."

The second argument was related to pressure from peers and families as well as from the media, which, in our commercialized world of immediate gratification and hedonism, encourages people to take risks, dictates current fashion and prioritizes pleasure over any other consideration. More and more women, especially adolescents and young women, are increasingly affected by this situation, which traditionally targeted its messages to men as part of the development of machismo.

In the focal groups with younger participants, there were constant references to what was called "men's social burden." One man commented: "We are always supposed to be ready for the chase, for sex with casual partners." In response, the young women indicated that they suffer from discrimination and subjugation and are forced to accept masculine behavior that debases and offends them. "Culturally, we always have been subjected to the oppressive power of men," said one woman, adding, "these days, men are encouraged to have sex all the time, this makes them insecure, and because of this, they commit adultery as a way of compensating for the expectation that men are studs. But if men really made commitments, then relationships would be more possible, more stable."

Gender stereotypes and the expectations that they generate conflict with the ABC message in the area of sexual abstinence, making the application of this strategy unlikely, above all among men. "I have two boys. One of them is already having sex; he has partners, and I try to tell him to go to the doctor. My other son is very passive. He tells me that he does not want to have sex yet, he is too laid back, and that worries me" (adult woman). Another participant spoke about the effects of the media on the behavior of young people and the difficulty that this implies for their sexual education: "We believe that young people don't see anything, but they are getting information from all sides, from the Internet, magazines, television, which encourages sex. So, how do you tell them to protect themselves from a young age?"

Just the mention of sexual abstinence in the focal group provokes laughter, whistles and joking murmurs, clearly communicating that the men and women present are unconvinced about this method of prevention. One young woman even said, "Since nobody is going to practice abstinence until they die, I think that the condom is the only solution."

Stable Partners

Women participants generally understood having a stable partner as having a single partner. In the words of two young indigenous women in Cali, "A stable partner is one who has only one girlfriend," "... he met her, and stayed with her for life and no one else." Students from ALPEINCO agreed: "I am stable as a partner because I am not in other romantic relationships," and "I think that a stable partner is, for example, that you are with only one person, and only that person, not with this one and that one, no ..." Although adult women in general share the younger women's view that a stable partner means a single partner, some qualified this association: "It depends on whether it is stable for her and for him, too;" "The problem is that a partner can be stable with you but take advantage of opportunities that come up, and so stable does not necessarily mean sole."

For a number of women, a stable partner is like a dream, a romantic ideal, perhaps their ultimate goal: "I think that it is better to be with someone, but with a wonderful person, to be able to trust and receive support always from that person" (adult woman). "You look for an ideal man, who pleases you in everything ... that is what you would want" (young woman from Jamundi).

The young male participants related the term "stable partner" more to a lasting partnership and the "seriousness" of the relationship with less emphasis on a single partner, leaving "the door open" for potential new partners. A number of their statements referred to this understanding: "A stable partnership is a serious relationship. It means not having other relationships. It is a partnership that lasts. A stable partner means you have been together for a certain time."

Another young man said: "I want to say something about stable partners. Sooner or later, if you have a stable partner you are going to break up, the relationship is not going to last your whole life, right or wrong? Let's assume that point, that you are going to get another partner. Right, let's assume that the next partner will also be stable. You are not going to know whether this new person had sex before, and you also had sex with your former stable partner, and so what I mean is that it's not only one person, but you also have your past, and with a new partner, it is one more past, even if you have a stable partner. So I think that the stable partner is an option, but is it a safe option? I don't think so."

The adult men were even more skeptical or, in the words of one, "more realistic": "'Manuela' is the only single partner. There's no one else. No partner is going to last your whole life." (4)

What do you need to build a stable couple?

Men and women of all ages agreed that a series of conditions were necessary:

"To trust each other, to talk" (young indigenous immigrant woman in Cali).

"To understand each other. Trust each other, respect each other, want each other, love each other, to talk, spend time" (young woman).

"I think that more than anything the issue is responsibility because as a couple both of them have to assume that responsibility" (young man).

"The characteristics of a stable partnership are love, trust, faithfulness" (adult man).

"The stable couple also is like a process because you have to get to know the person, and see if he/ she is who you think they are, talking is important" (young woman).

But "it is hard to achieve," commented one adult woman, summarizing what most of the women had expressed with regard to men's behavior: "You quickly say yes, but the man ..." "It's just that men are such dogs ... you know what a man is going to do when he's out ..." One adult woman commented, "In the environment in which we live, you know this as sure as science: inside the house he's mine, outside I don't know ... You say, yes, he is my husband, but when he goes to work, when he goes out with his friends, will he still be my husband?"

Another woman also included women in the uncertainty of stable relationships: "My mother says, for example, I speak for your father when he's at home because outside the house, I don't know about him, and it is the same with women." "For example, no man is going to stay with only one woman. I think that, for example, with marriages that last more than 40 years, the man always has had a mistress, and he doesn't know if his mistress has AIDS, and you don't protect yourself because he is your partner ... There is a lot of risk anyways ..." (young woman from Jamundi).

The men evidently have little faith in stable partners and even less in a single partner. Some opinions: "Stable goes between quotation marks because it seems to me that

really there is no such thing as a stable partner, because tomorrow she likes another person and has sex with them ...": "Nothing in life is safe, everything is a risk"; "It's just that we are men, we live our lives from day to day."

[ILLUSTRATION OMITTED]

For women, trusting in the strategy of a stable partner means running the risk of cheating and illness: "because the woman really loves him and believes the words he says to her" (young indigenous woman). "People who have some kind of illness can have it for years and continue to have sex, they can have it and not know they have it" (young woman). "But you know what a man is going to do outside of the house... he can be the typical cheater, he can have his woman, but at home he says, 'I love you, I want you,' but what do you know about where he goes ... and what he is going to do there? ... that also causes disease" (adult woman).

The men also emphasized the possibility of disease: "Even couples who are married and everything have caught the virus," commented one young man, while an adult man said: "Often, a woman's partner won't be able to tell her that he's been with so many people, nor that they have given him such and such a thing more because he is afraid of losing her."

In conclusion, the notion of the stable partner is so full of 'ifs' and 'buts,' as well as risks, that both woman and men have little faith in it. Even so, the concept continues to guide many decisions related to people's sex lives, especially for women, who feel pressure to assume the idea of a monogamous life and behave according to this ideal.

For men, the concept of a stable partner is more of a socially validated discourse that is repeated to lend themselves sexual legitimacy in a context in which promiscuity is frowned upon. But the perception we glean from the conversations in the focal groups is that few men believe in a stable couple relationship and are not very willing to incorporate this concept into their sex lives.

From both perspectives--female fantasies and male posing--the stable partner "method" will be of little use in preventing HIV/AIDS infection. Monogamy would only be real protection if the proposed behavior took into account the complex nature of this concept, with men and women on equal terms and with respect for the ethical requirements that both sexes spoke of during our conversations. The question that arises is: in this patriarchal context, how many women and how many men really are willing to take on the challenges involved in building a stable partnership?

[ILLUSTRATION OMITTED]

Condom Use

Both men and women participants in the Cali and Jamundi focal groups were aware of condoms as a preventive method and of the need to use one in their sexual relations:

"The condom is one of the safest methods. We should take advantage of it to prevent disease" (young indigenous immigrant woman, Cali).

"... because using a condom, it works, it's better to be prepared" (student at Don Bosco).

"Condoms are one option for avoiding STIs/AIDS" (adult woman, Barrio Las Orquideas).

"The condom is the latest creation to protect ourselves against AIDS, it is a safe method, it is double protection because it also protects against pregnancy: not pills nor any of the others do both" (young female student from Jamundi).

Men also argued in favor of condoms: "Well-being is more important than pleasure. Also, condoms have lubricants and everything. The lubricant makes penetration easy. I think the most important thing is to plan ahead and use a condom" (young man, 19). "You use it to avoid a number of things, if you are at the discotheque or something and have an opportunity, I think you have to use a condom because you don't know that person, that could seem annoying to a lot of people, but you should use one ..." (adult male).

However, after the focal group discussions we perceived that regardless of what participants were saying, few people are actually using condoms to protect themselves and their partners. Indeed, we know that a number of them never have used condoms.

As we noted in our field diary:

"Most of the group admits that they are not currently using any method to protect themselves from STIs/ AIDS. This is manifested in their nervous laughter, their silences and evasive behavior when directly asked what they are doing to prevent pregnancy and illnesses" (from a focal group with young immigrants).

"When we asked about condom use, most of the young people looked around, fidgeted constantly and changed positions: hands to their mouths, unfocused looks, evasive jokes and smiles. They were afraid to admit that they are not using condoms. When asked more directly, they admitted that they didn't use them and put forward different reasons to back up their answers" (group of young men and women from ALPEINCO).

"When we challenged their statements, brought their talk down to reality, we observed that the young adults bit their lips, shifted their legs, smiled timidly, and there were long silences" (group of young adults from Centro Don Bosco).

When we commented on their infrequent use of condoms, they justified it by saying they had difficulty in obtaining them (especially young people) or in carrying them (especially young women), decreased pleasure and awkwardness when putting them on. They also gave other, less coherent reasons including the small size of the condoms, how they change the form of the penis, how they could not have an orgasm while wearing one and how ineffective they were. In the words of one participant: "Because anyways condoms are not 100% safe, it doesn't matter, the virus is really small and can pass right through, and that's it."

Young Indigenous Immigrants

"People don't use them because they are embarrassed."

"Because they don't know how."

[ILLUSTRATION OMITTED]

Young Women

"... we don't use them because we want to experience the moment."

"I think people don't use them because it doesn't feel the same."

Adult Women

"Once I asked a friend of mine why it wasn't the same if you used a condom, and he said because the penis loses its shape, the head loses its shape, that's what he told me, he gave me that reason, like they don't have the same sensation."

"It is uncomfortable. Sometimes men don't have money, or the condoms are poorly located, in a bad place, or the condoms are really small. For others, because they don't like to use protection."

"Some men don't like to put them on, and women don't like them either. They say that when they are going to, what do you call it, have an orgasm, he doesn't feel the same and neither does the woman. They say it affects a man's development."

"Yes, wearing a condom does make a difference because I have used one for prevention with my partner, and we definitely used it for an emergency because I normally use the rhythm method, and yes, I think that using a condom lowers your risk of sexual diseases, but in terms of pleasure, that I didn't like ... because its hard for me to get condoms ... at first I got comfortable using one or two brands, but I felt bad using the rest. I did this in my stable relationship, we had a verbal agreement; but sometimes your doubts are too strong; we don't use condoms because he doesn't like it very much, I admit that I don't either, but sometimes they say it's the men who don't want to wear one... and it's not that he doesn't want to put it on, I didn't like it either, I take responsibility for that. I used it more because you have to protect yourself."

Young Men

"People don't use them because it doesn't feel the same."

"You feel less pleasure."

"Uncomfortable."

"You don't feel the same contact. Penetration isn't the same."

"Women say it is not as good that way."

"Condoms always make you uncomfortable, it is not the same. Also, women say they don't feel the same, that it's better without a condom."

[ILLUSTRATION OMITTED]

Adult Men

"I have used condoms, but I always go back to the same thing, it's not the same."

For the women, the low rate of condoms use is related to their passive, unempowered position in relation to the decisions of men, who are still setting the terms of sexual relations. To this gender subjugation we must add the female illusion of having a stable partner--the fantasy of the single partner for life that leads them to trust a man with whom they have formalized a more or less permanent relationship. A third important factor that impedes women from insisting that men use condoms is the stigma, discrimination and blame that is placed upon those who decide their partner must use one, especially adolescent and young women:

"We don't use it because men say that they don't feel the same" (young indigenous woman).

"When you have a stable partner, you don't use a condom any more. After you trust them, you don't use a condom" (young woman).

"We were given condoms in one campaign, my brother and I, but my mother saw them, and she was almost furious. But with my brother, she didn't do anything" (young woman).

"Because you have a stable partner and there is trust ... but the truth is that you don't know what they are doing out on the street ..." (adult woman).

"That's why I had so many children, because I could not use pills or the rhythm method, and the only way was condoms, I told him. And he said no, that you don't feel the skin contact, it is not the same, you lose contact, you lose the feeling, and he didn't like the smell. So we ended up doing it without a condom" (adult woman from Jamundi).

The men related the low rate of condom use to the construction of their male identity and the dominant hegemonic, patriarchal and machista masculinity (Quintero Castillo, 2003:7-12) that incites them to take risks, to be careless, to have sex with multiple partners, to search for new sexual experiences and to always be ready to respond to sexual demands to prove their manhood and virility, even if it puts at risk their own lives and the lives of their families. They use arguments like "inconvenience," "it reduces pleasure," the "impossibility of controlling your sexual instincts," men's invulnerability to illness and the "irresponsibility of women," who are made responsible for protecting themselves and their partners. In many cases, men restrict their condom use to collateral partners (others apart from the stable partner): condoms are for those from outside, not for those in the home.

"You use it to avoid a number of things, like if you are at the discotheque and you have an opportunity, I think that you have to use a condom because you don't know who that person is, but if it's your partner, I think that you are not going to wear a condom ..." (adult man).

"... You think about pleasure and all that. Sometimes, if you are with a really hot girl ... and you don't have a condom ... Because it drives you crazy: a girl comes and rubs up against you, she's really fine, and she wants it, and so 1, 2, 3 ..." (young man).

"If you go to a party and meet a girl and she wants to, you have to be careful, but if she has been your girlfriend for a while, well, there's trust and there you have to use a condom. With your stable partner if you don't want to have children, you have to use condoms, but if you are really sure, well, that's something else" (young man).

"Sometimes we don't have one with us, women expect us to have one, but if we don't have one right then, and if we have it in our wallets, it gets damaged. So, no condom, because women don't carry them" (young man).

"... the woman should be the one to have the condom" (adult man).

"Why? For example, my condom has come out broken. Condoms are ninety percent reliable, eighty percent. Anyways, using a condom is not one hundred percent safe... Nothing is safe in life, everything has risks ..." (young man).

Reflections on the Educational Workshops

These workshops were held in the Lopez Adentro, Jambalo, Caldono and Pueblo Nuevo Indigenous Reservations.

Sexuality

Adults in the indigenous communities demonstrated a broad view of sexuality that included emotions, ethical values and interpersonal communication.

For example, the indigenous men and women who participated in the Educational Workshop at the Lopez Adentro Reserve described sexuality as that which "defines us as men or women" and implies "responsibilities because it bears fruit." Sexuality requires "a feeling heart" as "it is a mutual relationship between two people with feelings and trust." Based on their cosmovision, they conclude that sexuality involves "feelings and behaviors [at the same time]. That is why it is a basic part of life."

The adults of the Jambalo Reserve expressed similar feelings: sexuality is not only biological, it is also social: "We live in stages, responding to our impulses and seeking pleasure." For some participants from the Pueblo Nuevo Reserve, sexuality "is the union of a couple in which opposite sexes relate; it signifies the harmony and happiness in our lives, it is a necessity of men as well as women, and also how you show your feelings to your partner."

[ILLUSTRATION OMITTED]

The young adult and adolescent participants placed more emphasis on the idea of "responsibility and respect in couple relationships." Those from the Jambalo Reserve associated sexuality with "having sex," "respecting your partner," "having a boyfriend, kissing him and loving him." One adolescent from Pueblo Nuevo stated that "sexuality is the way that each couple has for expressing love, you consider the other person's emotions and demand respect from others." For the young women of the Caldono Reserve, "sexuality is a couple having physical or intimate contact, who want to be together and are willing to be responsible," while young men in the same community expressed that "sexuality is a way of having sex with respect and responsibility towards your partner, it is a part of human life and how you make love with the person with whom you want to create a family."

Difficulties and Problems in Participants' Sex Lives

In referring to the difficulties and problems they faced in enjoying their sexuality in the indigenous communities, the adult participants recalled when sex education was considered a duty that was carried out by fathers and mothers in a particular way as part of their sons' and daughters' socialization process. This teaching relied on ancestral knowledge, on the indigenous tradition of close verbal communication among immediate family members and the community, using learning resources that the elder men and women created to deal with these topics: "Our grandparents never spoke to us in terms of sexuality, but they knew how to control us ... Before, they taught us how the seeds were formed, my mother warned me, restrained me, everything was bad, but she taught me ... they helped us to find a partner because for indigenous people sexuality is sacred... before we didn't know any sexual terms, AIDS, but our parents taught us, watched out for us ..." (young people of the Jambalo Reserve).

With the passing of time and the changes that have affected the indigenous culture (5), the tradition grew weaker: "Today, children know more than their parents," said one man from Jambalo, "Today, they think that falling in love only means risks, they only think about pleasure, they are not taught or warned."

At the core of this lack of sexual guidance, participants saw "the loss of respect for authority" when adults and their wisdom are no longer valued, consulted or heeded: "The elders' idea of sexuality still exists," one participant at the Educational Workshop in Jambalo, pointed out "but today, it is unknown, it has been lost."

[ILLUSTRATION OMITTED]

The conversations held during the encounters on the four reserves indicate that silence prevails today on the topic of sexuality in the indigenous context; it is a taboo subject that is not addressed sufficiently, not even in communities' organizational processes or future plans. Both young people and adults identified this silence as the main barrier to their personal and collective development and to the full expression of their sexuality:

"The worst thing is that sexuality is not a central issue in the communities or in the indigenous organization; no one talks about sexuality here" (adult woman).

"The subject of people living with HIV has not been addressed, and it should be ... the adults think that sexuality is something to be hidden. They keep it private and do not guide the young people, when the reality is something else" (adult man).

"When girls and boys reach adolescence, they begin to have boyfriends and girlfriends; this situation is not discussed at home because the family does not talk" (adult).

"The issue of sex is never spoken of in the indigenous communities. In education, we are not addressing this issue responsibly. We believe that this kind of education should be given only by the school teacher" (adult woman).

Participants identified problems that have arisen because there is no systematic, responsible sexual education based on the Nasa peoples' cosmovision. These problems have had negative effects on community life, not only with regard to sexuality but also related to the political, economic, cultural and social aspects of life in the reserves, as well. Some of these problems are:

- Young people receive strong negative messages about sexuality from the media, pornography, informal conversations on the street and other external agents.

- Acts of violence, abuse, rape and the sexual exploitation of girls, adolescents and women are prevalent.

- There is a strong presence of machista models that influence young men's development and encourage violence and risk-taking in sexual behavior.

- There are high rates of pregnancy among young women, which for many means dropping out of school and leaving the reserve because of the social stigma. This is also linked to higher rates of child abandonment and a high incidence of child abuse.

- People are misinformed and unprotected against HIV/AIDS and STIs.

The situation described above is made worse by poor information or misinformation on sexuality, the lack of space, means and opportunities to deliver appropriate sex education and the silence, mutual mistrust and disparagement that exist between young and old on the reserves. Furthermore, all of these factors increase the vulnerability and risk of the indigenous population--especially adolescents and young adults--to situations such as unwanted pregnancy, STIs, AIDS and sexual violence.

Additional findings of the Educational Workshops are described below:

a) There is a low perception of risk. Participants see HIV/AIDS as far removed from their own lives and focused risk on certain types of people--homosexuals, "overly promiscuous" men--while underestimating the very real risk to themselves.

b) The effects of migration. In the words of one indigenous adult man from Pueblo Nuevo: "Traveling to the city constantly increases the risk because of the type of spontaneous relationships that can occur, not only for the person who travels, but also for those who stay behind on the reserve, and in this way, the virus can reach the community."

c) Armed individuals--guerrillas, paramilitary soldiers, armed forces and police, either stationed in the area or passing through--who "have sex with the young women when they come and leave them pregnant when they go, and you don't know how many illnesses they leave behind that can be spread around the community" (young man from Lopez Adentro).

STIs and AIDS

To find out what information these groups already had about STIs and AIDS, we organized hour-long discussion groups in the reserves with male and female participants who spoke openly about the knowledge they had acquired from magazines, videos, television, informal conversations and educational activities.

For the young women of Lopez Adentro, "AIDS is a deadly disease, and there is also gonorrhea, that happens when someone sleeps with many people, people get weak and die."

Young men in the same reserve stated, "AIDS is an illness that happens to homosexuals, those who sleep around, people get really thin and then die. There is also gonorrhea, syphilis, scabies and cancer."

The girls of Jambalo thought that AIDS "is an illness that men get, and they die because they were irresponsible. You catch it through blood and sex, and the men who catch it also try to give it to other people in revenge because they want to die with other people. The ones who have it get lumps, and their skin turns purple." On the same topic, the boys from the reserve commented that "men get it from not being careful, and they die immediately, they get thinner and weaker until they die."

The group of adolescent boys who participated in the Pueblo Nuevo Reserve encounter said that the disease "is transmitted by sex with a partner who had sex with another person who has it, and if it is treated in time, the illness does not advance." Meanwhile, a group of adults asserted that "it is a contagious illness that is passed through sex and also by the use of some contaminated products or objects, like syringes."

The young women of Pueblo Nuevo commented that "AIDS is transmitted more than anything by sex and by infections or from having sex every day with a several people." Young men of the same reserve also identified "cancer and gonorrhea" as STIs.

As we can observe, the information available in the reserves is deficient and confusing, and more-or-less accurate knowledge is mixed with misinformation. The following aspects deserve special note:

1. The association of AIDS with imminent death, which could lead to defeatist and fatalistic attitudes among those who are infected with HIV. If this way of thinking is generalized among indigenous communities, it raises certain questions: What is happening to those who are infected? How are indigenous communities, institutions and organizations dealing with positive diagnoses? Are these people dying alone, in silence, hidden away, without proper medical, psychological and social treatment that could prolong their lives? How much stigma and discrimination is present in this way of approaching AIDS, and how do the stigma and discrimination hinder prevention and even encourage the spread of the disease? (6)

2. The idea that AIDS is a preeminently male disease that affects promiscuous men and/or homosexuals. Interestingly, women are absent from the stories about AIDS. The fact that women are not thought to be at risk or even affected by the problem makes them more vulnerable. Similarly, the association of AIDS with promiscuous men also can represent risks for those men who do not consider themselves promiscuous and, therefore, do not protect themselves in their sexual relations.

3. There is a misconception that multiple sexual relations are required to be infected ("sleep with many people" "have sex every day with a number of people") when actually one unprotected contact can be enough to become infected with HIV or other STIs or to become pregnant. This was a recurring theme in the Educational Workshops, above all, during the breaks when we listened to the young people discussing the issue without having any clear answers. Another idea worth noting was participants' belief that women "who didn't have sex very often" or "were having sex for the first time" supposedly were not at risk of becoming infected. (7)

4. We observed a serious lack of knowledge of STIs. In very broad terms, participants' had some information on gonorrhea and pubic lice (crabs), but knew very little about herpes, hepatitis B and C, genital warts, syphilis, etc. Of particular concern is their lack of knowledge of the symptoms of certain STIs and how to deal with them. The fact that sexuality is a taboo topic in these indigenous communities makes this aspect particularly worrying. This combination of negative circumstances increases people's vulnerability and the risk of not getting treatment in time for such illnesses, which can predispose a person to HIV/AIDS infection if not treated properly. (8)

[ILLUSTRATION OMITTED]

STI and AIDS Prevention

Indigenous participants in the Educational Workshops mentioned abstinence, a stable partner and condom use as the best methods to prevent STDs and AIDS, demonstrating their awareness of the ABC message. Their contributions emphasized a greater trust in condoms for protection and much skepticism in regard to abstinence and a stable partner as practical everyday solutions.

In regard to renouncing sex, for example, a young woman from Pueblo Nuevo commented, "Sexual abstinence is not possible because men can't bear it, because they get the idea into their heads and they can't stand it." A leader of the Lopez Adentro Reserve clarified, "For our community, sexuality is sacred and has to be practiced, it should not be stopped, but it should be done with responsibility." This idea, which was reiterated a number of times by the older participants, is part of the indigenous cosmovision that makes sexual abstinence not only unlikely but also inappropriate and frowned upon.

At the same time, the older adults--both woman and men--who were more in agreement that a stable partnership is the foundation of relationships between men and women and a good way of preventing AIDS. But they admitted that in the community, especially among its younger members, this method is not very realistic.

Young men and women in the discussion groups rarely referred to the idea of a stable partner and did so only obliquely, showing that this form of relationship is not one of their day-to-day concerns or interests. A young woman from Lopez Adentro frankly confronted the other participants at the Educational Workshop with these words: "The truth is that ... the idea of a stable partner does not occur to us ... people here are not aware, and they don't see the truth. In practice, stable partnerships do not occur. Fidelity! Men, faithful?" The question was left hanging, accompanied by the laughter of those who had heard it.

During the Educational Workshops to explore STI and AIDS prevention, condom use was the most commonly mentioned method of preventing illness and unwanted pregnancy. Despite the positive image, however, it seems that neither male nor female participants actually use condoms regularly.

One researcher asked: "When you are with your partner, has it ever occurred to you at any time that you could get this type of sexual disease?"

Group: silence ... laughter ...

Researcher: "Remember that you have to protect yourselves. You can use a condom. Do you use condoms?"

Group: Laughter ... evasive looks ... murmurs of "no"...

Participants in the reserves offered reasons for not using condoms that are closely linked to men's responses in the focal groups: loss of pleasure, inconvenience, unreliability, difficulty in maintaining an erection. Women were almost always silent during these discussions, both in the larger group and among the smaller, women-only groups. This indicates that: a) they are not well informed on this issue; b) many of them are probably not used to using condoms in their sexual relations; and c) they are embarrassed talking about a topic that they feel is mostly a men's issue. In short, they lack a sense of empowerment that would enable them to negotiate the use of condoms on an equal footing with their male partners.

For their part, the young adults referred constantly to the difficulties they experienced in obtaining condoms: "It is very difficult to get them here, they are very expensive"; "in the reserve, they don't sell them to us anywhere"; "once you buy them, you are branded." In comparison, the adult participants felt that condoms were for the young, not for them: "We have stable partners, there is no need for condoms" (adult from Jambalo). "I think that it is the young people who should use those condoms; people of our age, why? I have lots of children, I have eight, and it would be good to teach the young people how to use condoms so they don't have so many children" (adult woman, Caldono).

Finally, adults of both sexes recommended not using condoms as the only method of prevention, not even used together with imported contraceptive products ("other things that come from outside"). "All of this should be combined with our beliefs," said one, "our traditional knowledge of medicinal plants, birth control with medicinal plants, and the most essential thing is to educate the community in our own ways."

Conclusions

The ABC message has been significant because it has promoted basic information on STIs, HIV and AIDS. In the focal groups held in Cali and Jamundi and the educational workshops conducted on the indigenous reserves, the stories and comments told us that participants generally were familiar with the message and had appropriated some of its content, incorporating it into their discourse and reasoning processes. This does not mean, however, that their sexual attitudes and behavior are necessarily in line with the information they have and expressed in the discussions. Indeed, in practice, abstinence, monogamy and condom use are impeded by social, cultural, economic and political barriers unique to each context. These factors often combine to leave the ABC message in the conceptual plane, having little real impact on the protection of men and women's sexual and reproductive health.

[ILLUSTRATION OMITTED]

One serious barrier to the acceptance of the message is the low perception of risk, a phenomenon often due to cultural factors, especially those related to building identities and gender relationships. Women in stable conjugal relationships may place themselves outside of the "vulnerable groups" category, trusting their partners and leaving the responsibility of protection to them. In contrast, adult men overestimate their male power, they feel that only the weak, homosexuals, sex workers and young men are at risk. Young men, for their part, exclude themselves from risk categories because they also associate the problem with homosexuals and sex workers. Young women demonstrated their lack of knowledge and lack of empowerment in demanding their rights, while many live in the romantic fantasy world of the stable, lifelong partner.

In summary, we found a population that underestimates the risks of STIs and HIV/AIDS, does not accept its own vulnerability and looks at such problems as far removed from their own lives, as something that can happen only to others.

Sexual abstinence confronts realities such as the desire to have children, the pursuit of pleasure, cultural pressure to be sexually active, coercive sexual relations, violence and sexual abuse. The idea of the stable partner clashes with inequities in gender relationships--almost always to the detriment of women--and not all men or women are ready to assume the ethical requirements involved. Condom use is low because of beliefs that discourage their use, machista cultural imperatives, the difficulties women face in demanding their use and the inconveniences in obtaining them, particularly on the indigenous reserves.

[ILLUSTRATION OMITTED]

Because of the serious obstacles people face in applying the ABC message in real-life, we must reconsider how this message has been structured and disseminated. We must come down to earth from this idealized world where all are equally free to make decisions, to choose to abstain from sex if they wish, to remain faithful to one partner and/or to use or condoms regularly.

Instead, we must contextualize this message in keeping with the daily lives of those whom we want to reach, real people who experience discrimination because of their gender, age or economic and cultural status. Special effort, therefore, must be given to confronting today's capitalist globalization, the political, social and economic model that imposes competition, consumerism and commercialization on humans and our lives, which promotes hedonism as the highest aspiration and immediacy as the formula for day-to-day living. These discourses, transmitted above all through the mass media, have their strongest and most profound effects on youth and increase the risk of STIs/AIDS/violence by encouraging low perception of risk, lack of concern for others, machismo and all forms of fundamentalism.

Furthermore, in reconstructing and disseminating the ABC message, we should recognize, value and rethink gender relationships (incorporate a gender perspective) and relationships among cultures (an intercultural perspective) to collectively configure an ongoing dialogue that includes

the participation of women and men as active subjects in actions to prevent STIs/AIDS.

In addition to the findings described above, the exploratory study also identified a fair number of young men and women, as well as some adults, who were willing to continue reflecting upon and transforming not only their sexual lives but also their lives in general and encouraging others to do the same. This potential exists in our communities and should be taken into account and given a leading role--through peer education, for example--in the programs and activities focused on avoidance of problems related to sexuality. (9)

Women occupy a special place in this hopeful scenario: they have demonstrated their desire and willingness to find ways of informing and educating themselves on topics that are important for their sexual and reproductive lives. In a context in which the ABC message doesn't make sense for most women, it is vitally important to cultivate their interest, channel their expectations and develop their skills as advocates and promoters of prevention. Given their lack of social and economic power, women are not currently in a position to negotiate relationships based on the ABC principles. From their subordinate positions, insisting on abstinence or condom use are not real options. Even marriage and stable relationships do not provide them with effective protection against HIV: most of the women living with HIV were infected by their stable partners (Garcia Bernal, 2004:10).

At the same time, men must be given a more active role in this area. As intermediaries in the process of questioning the "manly" model of masculinity, they can reinterpret their perceptions, attitudes, roles and relationships; deploy new ways of understanding; and come to terms with their male identity and sex lives in a context of respect and equity, care for themselves and their partners, open dialogue, and the rejection of coercion and violence as expressions of their sexuality.

The ABC message will continue to be ineffective for both women and men if it remains in the realm of medical, technical and scientific information, trying to reach people on a purely intellectual plane. It must move beyond the simple transmission of knowledge to address other levels through which real change can be achieved in people's sexual ideas, attitudes and practices.

The ABC message must be grounded in the ethical framework of the individual and groups to which it is targeted. To this end, we must incorporate ideas of human existence, human rights--in particular sexual and reproductive rights--life plans, ethical principles, self-realization and decision-making, "where responsibility and freedom of action are overlaid with respect for the other" (Luque Nunez, 2004:22) and in which interpersonal and social relationships are based on mutual solidarity.

Bibliography

Aigneren, Miguel (2004) "La tecnica de recoleccion de informacion mediante los grupos focales." In: CEO Revista electronica, No 7. Online at http://huitoto.udea.edu.co.

Alcaldia de Santiago de Cali-Secretaria de Salud Publica Municipal de Cali-Taller Abierto (2004) Estudio sobre conocimientos, actitudes y practicas de la sexualidad en la poblacion de Cali.

Anderson, Karen (1998) "Women, AIDS and Poverty in Urban Shantytowns in Chile." Gomez, Adriana; Meacham, Deborah, eds. Women, Vulnerability and HIV/AIDS: A Human Rights Perspective. Women's Health Collection, No 3. Santiago, Chile: Latin American and Caribbean Women's Health Network, 17-26.

Arteaga Bolanos, Maribel; Estrada, Victoria Eugenia (n.d.) Modulos educativos en salud sexual y reproductiva. Cali: Medicos Sin Fronteras.

Bonilla-Castro, Elssy; Rodriguez Sehk, Penelope (1997) Mas alla del dilema de los metodos. La investigacion en ciencias sociales. Bogota: Grupo Editorial Norma.

Bonino Mendez, Luis (2004) "Micromachismos. La violencia invisible en la pareja." Online at http://www.europrofem.org/02.info/22contri/2.05.es/2es.masc/ 54es_mas.htm.

Cossio Moncada, Myriam Janeth (2004) Cronicas de vida. Cotidianidades de mujeres viviendo con VIH. Bogota: UNFPA/UNAIDS.

Catolicas por el Derecho a Decidir (2004) "L@s jovenes tambien tienen derecho a tener derechos." In: Revista Conciencia Latinoamericana. Vol XIII, No 9.

Estrada T., Victoria Eugenia (2004) Informe epidemiologico HIV/AIDS, Cali, ano 2003. Cali: Secretaria de Salud Publica Municipal de Cali. Dsd.

Family Care International (2000) Factsheets on Sexual and Reproductive Health.

Farfan, Alexandra (2004) "Mas mujeres con VIH en America Latina." In: Semanario Tiempos del Mundo, 7(50):24.

Fontas, Carina et al. (2004) "La tecnica de los grupos focales en el marco de la investigacion sociocualitativa." Online at http://www.fhumyar.unr.edu.ar/ carrerasdegrado/cienciasdelaeducacion/ trabajodecampo2005/profesoras.htm.

Galeano Velasco, Monica (2000). "Aspectos eticos y legales. Cuando lo privado no debe ser publico." Ministerio de Salud de Colombia. Proyecto: Una Opcion de Convivencia. Fasciculo No 3: Aspectos eticos y legales del VIH y el SIDA.

Garcia Bernal, Ricardo (2004) "Mujer, ninas, VIH y SIDA." In: Revista Indetectable, 7(24): 10-12.

Luque Nunez, Ricardo (2004) "Etica y SIDA." In: Revista Indetectable, 7(24)22-24.

Martinez Miguelez, Miguel (2004) "Los grupos focales de discusion como metodo de investigacion." http:// prof.usb.ve/miguelm

PROFAMILIA (2000) Salud sexual y reproductiva en Colombia. Encuesta Nacional de Demografia y Salud. Resumen Region Pacifico.

Quintero Castillo, Wili (2003) Masculinidades y Salud Sexual y Reproductiva: Marco de referencia. Cali: Secretaria de Salud Publica Municipal de Cali/Taller Abierto.

Rashidah, Abdullah (2004) "Entendiendo las responsabilidades de los hombres en cuestiones de igualdad de genero." En: Boletin de la Red Mundial de Mujeres por los Derechos Reproductivos, No 82. 10-11.

Secretaria de Salud de Jamundi (2004) Situacion actual del HIV/AIDS y de tuberculosis. Dsd.

UNAIDS (2000) "Los varones y el SIDA: Un enfoque basado en consideraciones de genero." Online at http://genero. bvsalud.org/lildbi/docsonline/0/0/100MFN_3076_CIEM_AV_2249.pdf.

UNAIDS (2004a) "Las mujeres y el SIDA."

UNAIDS (2004b) "Resumen mundial de la epidemia del SIDA."

UNAIDS/Colombia, Ministerio de Salud (1999) Infeccion por VIH y SIDA en Colombia: Aspectos fundamentales, respuesta nacional y situacion actual. Un balance historico hacia el nuevo siglo.

UNFPA. Aliados para el cambio. Cooperacion de los varones en la prevencion del HIV/AIDS. Dsd.

Valdespino, Jose Luis (1993) "Las encuestas CACP. Conceptos basicos." In: Manual de encuestas sobre conocimientos, actitudes, creencias y practicas (CACP) sobre SIDA y STDs. Washington, D.C.: PAHO/WHO.

Velandia, Manuel Antonio (2004) "[??]Disfrutan los colombianos su vida sexual?" In: Revista Semana, No 1, 155.

To this end, we should ask the following questions:

* What is understood as a stable partner?

* Is it the same as a single partner for life?

* Is this realistic?

* What is needed to achieve it?

* What are the risks implied in basing our sexual practices on our trust in a stable partner?

We also must ask ourselves:

* What role do condoms play in our sex lives?

* What does condom use imply in the context of a stable relationship?

* Why do I use condoms or not use them?

* Who decides whether or not to use a condom?

* What are the risks of using and not using a condom?

* How do all of these issues relate to my vulnerability to HIV/AIDS?

RELATED ARTICLE: Indigenous peoples and a cultural approach to HIV/AIDS prevention and care.

Adopting a cultural approach to HIV/AIDS prevention and care means that the population's ways of life, value systems, traditions, beliefs, religions and fundamental human rights are taken into consideration in designing and implementing programs to shift behavioral patterns.

This approach is especially important for indigenous peoples as they have distinct cultures and cultural beliefs that often differ from the dominant society, and existing prevention programs sometimes do not address these populations in appropriate ways.

Many prevention and care interventions in the past have not been modified with cultural appropriateness in mind. The UNESCO-UNAIDS Project entitled, "A Cultural Approach to HIV/AIDS Prevention and Care," launched in 1998, stimulates discussion on prevention and reconsiders prevention strategies, programs and projects from a cultural perspective.

The project is comprised of action-oriented research, training and sensitization, the development of methodological tools, implementation of pilot projects and networking. The activities also may include work on specific issues, such as the most vulnerable populations: migrants, indigenous populations, youth, women; stigma and discrimination; the role of religious leaders and traditional healers in HIV/AIDS prevention; or the use of the arts in the fight against HIV/AIDS.

Project initiatives have thus far included: educational opportunities for youth on HIV/AIDS prevention; development of educational materials in local languages; and the use of theater, art and media to convey HIV/AIDS information and reduce discrimination and stigmatization, etc.

Within the framework of the project UNESCO is cooperating with the South African San Institute on an action research project with the San peoples of the Kalahari Desert. The project report is being finalized and details the experiences and findings of a team of Khomani San health educators facing HIV/AIDS, health care and survival challenges in the southern Kalahari. The report outlines how traditional knowledge and the core culture of the San people can be a resource for facing the HIV/AIDS epidemic.

UNESCO is also working in Guatemala on culturally appropriate education and communication for behavior change among indigenous populations (i.e., Maya and Garifuna) in five countries of Central America.

* For more information, visit the UNESCO website at http://www.unesco.org/aids.

Notes

(1.) "0.33% of the Cali population is affected by HIV (total cases as of December 2003: 7,666). This figure is based on the cases notified at the Epidemiology Unit of Municipal Public Health Department. Nonetheless, this data is affected by the high rate of under-registration of this pathology due to stigmatization, which discourages people from seeking a diagnosis or making it public, and social-economic factors which hamper opportune access to a diagnosis; (for each case diagnosed, there are nine others undiagnosed) and due to the failure of private health companies to systematically report cases" (Estrada, 2004:4).

(2.) "The AIDS epidemic is affected by a growing number of women and girls. Around the world a little under half of all people living with HIV are women. In most of the regions, a growing proportion of people living with HIV are women and girls; this percentage is increasingly slowing, above all in Eastern Europe, Asia and Latin America." UNAIDS (2004a).

(3.) See Martinez Miguelez (2004), Fontas (2004), Valdespino (1993), A-25, A-26.

(4.) "Manuela" is a popular term for masturbation.

(5.) "The problems of public health and the decline in the quality of life in the indigenous communities are closely linked to the processes of change being experienced in the region as manifest in economic and social activities that have a direct and indirect impact on the environment and the health of the indigenous population. The installation of large-scale petroleum production, the development of roads, hydroelectric dams, illegal cultivation and other activities in the indigenous zones generate a wide array of health concerns ..." UNAIDS/Colombia, Ministerio de Salud (1999), p. 13.

(6.) From our Field Journal: The researcher asked "Have you heard of or seen someone with AIDS in the Reserve or somewhere nearby?" The group of young women responded: "We don't know of any cases yet." "But do you think that there could be?" Group response: Evasive glances, murmuring, silence, laughter.

(7.) From our Field Journal: In one of the breaks during the Educational Workshop, a group of five girls asked us: "Professor, is it true that in the first sexual relation you can't get AIDS? That in the first sexual relation you can't use a condom? That in the first sexual relation you can't get pregnant?"

(8.) As a young man from the Lopez Adentro Reserve stated, "We were out with my uncle in the field, and he and some of his friends were telling a man that in order to avoid sexually transmitted infections before sex, the best thing was to drink your own urine and then nothing would happen to you; and if you had a chancre, you could get rid of it with grain alcohol or gasoline. That's what I heard when we were near the field with my uncle and his friends, and they didn't see us, but we paid attention to what they were saying."

(9.) Some young people of both sexes took part in a follow-up activity to the Exploratory Study, a Training Plan for Motivational Speakers in HIV/AIDS Prevention, organized by Taller Abierto. They will organize Educational Workshops and Consciousness-Raising Campaigns in their communities in which they will be agents in charge of motivating the activities.

[ILLUSTRATION OMITTED]

Opinions and Experiences on the Topics Under Study

                  Women under   Women over   Men under   Men over
                  19 Years      19 Years     19 Years    19 Years
                  of Age        of Age       of Age      of Age

Vulnerability

Sexual
Abstinence

Stable Partner

Condom Use