Sexual and reproductive health in the Garifuna communities.

Since 1985, the Honduran Black Women's Network (ENMUNEH) has been dedicated to improving quality of life in the African-descendant community with a focus on prevention and timely care. In early 2003, the Network launched a sexual and reproductive health program with an emphasis on the promotion of safer sexual practices and prevention of sexually transmitted infections (STIs) and HIV/AIDS using a rights-based approach. An important component of this initiative is training and social communication in health, which helps to reinforce workshop topics and encourages a transformation from harmful lifestyles to healthy habits.

This program operates in the largest African-descendent settlements of the Garifuna ethnicity in the provinces of Atlantida, Colon and Cortes.

Garifuna women suffer the same prejudices and taboos currently endured by the majority of Latin American women. The HIV/AIDS epidemic is a serious concern that is aggravated in large part by the prevalence of machismo in many countries. In Honduras today, a significant number of African-descendant women live with HIV/AIDS.

After carrying out an analysis of the health situations of black women, the Honduran Black Women's Network incorporated a methodology including training and direct action. In this way the Network uses various tools to improve black women's self-esteem and encourage their empowerment to break cycles of physical and sexual violence. This strategy encourages women to take control and make autonomous decisions about their sexual life. We offer women the chance to know and understand their human rights and to defend them in specific situations. Similarly, we work to arm women with critical knowledge of laws that affect their lives and appropriate legal recourse in response to situations of abuse.

A socio-cultural study was designed utilizing observation, in-depth interviews and focus groups. The objective of the project is to appraise knowledge, attitudes and practices of women in these communities, especially topics dealing with sexuality, reproduction, sexually transmitted infections and HIV/AIDS. With this knowledge, the Network has successfully established strategies and methodologies for training that use participatory methods and a learning-action approach.

The Network also uses local expertise when working with adolescents, women and men from low-income sectors, utilizing their traditional spiritual and medical practices (bulleis). For example, midwives were recently invited to take part in activities.

In the work of promoting healthy lifestyles, ENMUNEH also carries out a training program in various issues dealing with those living with HIV/AIDS (PLWAs), including human rights education, which in the short-term has brought about changes in sexual behavior. These sessions also have encouraged participation by men, who previously were resistant to support groups. These self-help groups have helped participants to be more assertive and effective in their daily lives.

The main lessons of our experience can be summarized as follows:

* In the identification of knowledge, attitudes and practices carried out before the training sessions, the majority of those responding mentioned the lack of knowledge regarding their own sexuality, almost always referring to sex itself. The participants often did not understand why certain illnesses were called "sexually transmitted infections." We were especially surprised that most of the participants only identified gonorrhea and syphilis as STIs.

* In general, prevention of pregnancy is considered the woman's responsibility. Pregnancy and related topics are taboo and never discussed between parents and children.

A survey after the training courses revealed changes that might not translate into altered behaviors but did signal a transfer of knowledge and internalization of concepts. This has taught us that despite the low levels of education in these communities, a positive outcome is always possible when we involve the community and incorporate people's opinions into program design and delivery. The active participation of the community in these processes should be the point of departure in all actions.

With regard to HIV/AIDS and STI prevention, young people have information about the options of abstinence, maintaining monogamous relationships based on trust and fidelity, and the consistent use of condoms. However, they also know the negative and positive aspects of each method, and while they assert that abstinence is the only absolutely foolproof method, they doubt that this is a realistic option in their lives.

Self-care Campaign

While the self-care campaign primarily targeted PWLAs, this activity is applicable to the entire community. The primary objective is to enhance the health and quality of life of the participants as protagonists responsible for their own well-being. To this end, workshops are carried out, and house calls are made to evaluate health progress and to educate family members of those living with HIV/AIDS so they can also benefit from self-care methods.

This exercise proposes the following basic tenants:

1. You should always use condoms correctly in each penetrative sexual act to:

* prevent the transmission of HIV to your partner;

* protect yourself from HIV re-infection that can cause a more rapid deterioration of your immune system; and

* prevent other sexually transmitted infections.

2. Enjoy techniques of safer sex that allow you to give and receive pleasure without penetration such as fantasies, erotic games, or mutual masturbation.

3. Reduce the number of sexual partners to reduce risk of transmission and exposure to the virus.

4. The condom is a good method for avoiding pregnancy, but not the only one. However, condoms are the best methods of preventing the transmission of HIV and STIs.

5. Seek medical treatment immediately if you become pregnant and you or your partner are HIV positive.

For more information, contact:

Enlace de Mujeres Negras de Honduras, ENMUNEH e-mail: [e-mail]

Bertha Arzu Cacho

The author is the President of Enlace de Mujeres Negras de Honduras (ENMUNEH, Honduran Black Women's Network) and an activist for the rights of African-descendent women.