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AIDS:

WHAT YOUNG PEOPLE THINK

ABOUT IT

EDUCATIONAL PRACTICES AND POLICIES

UNESCO BRAZIL Editions

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UNESCO BRAZIL Editions

EDUCATION FOR HEALTH Series, Volume 1

Coordination/Compilation:

Cristina Raposo

Youth Working Group:

Ana Beatriz dos Santos

Ana Paula da Silva

Daniel de Castro Leite

Marco Antônio Franco Amaral

Mêires Moreira da Silva

Élida Miranda dos Santos

Sérgio de Cássio Souza Nascimento

Technical Writing

Cristina Raposo

Katia Guimarães

Mariana Braga

Matias Spektor

Youth WG

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AIDS:

WHAT YOUNG PEOPLE THINK

ABOUT IT

EDUCATIONAL PRACTICES AND POLICIES

Brasilia, December 2003

UNESCO Brazil Publishing Council

Jorge Werthein

Juan Carlos Tedesco

Cecilia Braslavsky

Adama Ouane

Célio da Cunha

Education for Health Committee

Cristina Raposo

Alessandra Schneider

English Translation – Die Press

English Revision – Alessandra Furtado e Glen Hertelendy

Diagramming – Eduardo Perácio (DPE Studio)

Editorial Assistant – Rachel Gontijo de Araújo

Graphics Project – Edson Fogaça

Series EDUCATION FOR HEALTH volume 1

United Nations Education Science and Culture Organization

Brazil representation

SAS, Quadra 5, Bloco H, Lote 6, Ed. CNPq/IBICT/UNESCO, 9º andar.

70070-914 – Brasilia – DF – Brazil

Tel.: (55 61) 2106-3500

Fax: (55 61) 322-4261

E-mail:

UHBRZ@unesco.org.br

UNESCO BRASIL Editions

CDD: 362 AIDS: What Young People Think About It. Brasilia: UNESCO,

2002.

84p.

1. AIDS – Youth I. UNESCO

UNESCO, 2003

Division of Women, Youth and Special Strategies

Youth Coordination Unit/UNESCO-Paris

ISBN 85-7652-011-7

INDEX

FOREWORD.................................................................................. 07

ABSTRACT..................................................................................... 09

ACKNOWLEDGMENTS.............................................................. 11

YOUTH ACKNOWLEDGMENTS............................................... 13

INTRODUCTION.......................................................................... 15

UNAIDS Thematic Group: Efforts in Brazil................................... 19

Reasons for Having a Youth Working Group.............................. 20

About the Methodology Used with the Youth Working Group.. 22

A Brief Overview of the HIV/AIDS Epidemic in Brazil.......... 26

AIDS AND VULNERABLE POPULATIONS.............................. 31

Recommendations...................................................................... 33

AIDS AND DRUGS....................................................................... 35

Recommendations...................................................................... 36

AIDS AND THE ADOPTION OF PREVENTIVE

PRACTICES............................................................................... 39

Recommendations...................................................................... 41

AIDS AND PREVENTIVE EDUCATION IN THE SCHOOL

CONTEXT..................................................................................... 43

Recommendations...................................................................... 44

AIDS AND WORK........................................................................ 49

Recommendations...................................................................... 50

AIDS AND THE MEDIA.............................................................. 53

Recommendations...................................................................... 54

AIDS AND YOUNG HIV CARRIERS.......................................... 57

Recommendations...................................................................... 58

CONCLUSIONS............................................................................. 61

YOUTHS BIOGRAPHIES............................................................. 67

GLOSSARY.................................................................................... 71

BIBLIOGRAPHY........................................................................... 79

ELECTRONIC REFERENCES.................................................... 83

UNESCO BRAZIL Notebooks

FOREWORD

HIV has brought up, in a particular manner, the need to “untie a

knot.” This knot represents the challenge to the collective health and

education policies worldwide and the questions posed by such a challenge:

How does one go about changing the behaviors of individuals when

those behaviors are linked to affection; when they take place within the

private lives of couples and are rooted in social-cultural aspects?

Furthermore, how does one involve youth in the process of changing

their behavioral, affective and cognitive paradigms? Understanding the

sexual behavior of young people and working with this population in

the era of AIDS has become a priority in Brazil’s strategy for combating

the emergence of this national epidemic.

This publication contains the conclusions of a project known as

Young People Commitment and Co-Responsibility in Preventing the

Spread of HIV/AIDS, or the UNAIDS Youth Working Group (Youth

WG). This project was conducted with the resources of the Joint

United Nations Program on HIV/AIDS (UNAIDS), and its main goal

was to promote the inclusion of a youth perception in the formulation

and execution of HIV/AIDS-related policies. The United Nations

Education Science and Cultural Organization (UNESCO) and

UNAIDS endeavoring to strengthen youth participation and stimulate

techniques for the prevention of HIV/AIDS and drug abuse among

Brazilian youth. This effort reinforces the essential role that youth

must play in formulating the preventive efforts and policies to be

adopted by Brazilian public authorities, civil society organizations and

the private sector.

Seven youths coming from civil society organizations and appointed

by the Brazilian UNAIDS Thematic Working Group assembled in five

meetings from 2000 to 2002 to discuss issues relevant to the epidemic.

Debates centered on such topics as youth participation, sexuality, drugs,

AIDS at work, young HIV carriers, public healthcare services and AIDS

in the school context, among others. The regional, social and cultural

factors identified in these young people thus imbued the Youth WG

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with the necessary diversity to reinforce preventive education efforts in

the context of peer groups led by young people in various areas of the

country.

The fact that we are dealing with such delicate areas such as STD/

AIDS and drug-abuse prevention, especially from a youth perspective,

makes the implementation of this project even more significant. While

the implementation of policies based upon the decentralization principles

advocated by the Brazilian Government represents a unique opportunity

to develop potentials, augment capabilities and combine efforts in such

crucial areas as health and education, it also represents a formidable

challenge for Brazil, a country of continental dimensions and dramatic

regional differences.

It is important to point out that the development of the UNAIDS

Youth WG—the first among Latin American countries—was based on

initiatives designed to promote the ability of young people to reduce

the risk of HIV infection while taking into account the psychological,

social, cultural and cognitive aspects. The exploration of these themes

is highly relevant to the establishment of new initiatives that promote

youth participation, behavioral changes, citizenship and solidarity.

We have no doubt that through this act, UNESCO and UNAIDS

are contributing toward the formulation of public policies that reserve

a special place for young people in the augmentation and delivery of

educational and health care public services, as well as in the services

provided by the organized civil society.

We are also convinced that the publication of this book represents

a step forward in broadening our knowledge of the epidemic in Brazil

through a youth perspective, providing the necessary elements for public

debate and effective action in regard to the relevant issue.

Jorge Werthein

UNESCO Director in Brazil

Rosemary Barber-Madden

United Nations Population Fund (UNFPA) Representative in Brazil

President of the UNAIDS Thematic Working Group in Brazil

UNESCO BRAZIL Notebooks

ABSTRACT

It is a fact that more than half of today’s new HIV infections

occur among young people. More than two decades after the report of

the world’s first case of AIDS, youths remain uninformed about their

own sexuality, not to mention about sexually transmitted diseases.

Although they know or are of somewhat aware about AIDS, they do

not believe they are actually at risk.

How can we contribute to the inclusion of young people in the

AIDS debate and make them more aware that they share the

responsibility for curbing the impact of this epidemic?

This publication is the result of the project funded by the UNAIDS

Young People Commitment and Co-Responsibility in Preventing the

Spread of HIV/AIDS. The primary objective was to include the

perceptions of youth in the formulation and implementation of HIV/

AIDS policies, thereby enhancing the involvement of youths in the

containment of the epidemic.

This initiative gathered seven youths from civil society organizations

of different Brazilian geographic regions and social contexts. Over a

period of two years, they discussed their perceptions on relevant issues

regarding the epidemic. Subjects in the discussions included youth

leadership, sexuality, education, drugs, the public health system, AIDS

at school, AIDS in the workplace and others. It is important to note

that the Youth WG, the first of its kind in Latin America, was based on

initiatives that seek the development of life skills among Brazilian youth.

This publication is thus intended to raise awareness by promoting

strategies to respond to the HIV/AIDS epidemic, taking into account

the participation of youth in the policy-making process and the

implementation of preventive efforts.

UNESCO BRAZIL Notebooks

ACKNOWLEDGMENTS

This publication was made possible thanks to the direct and indirect

efforts of countless people who supported and encouraged our work

throughout the past several months. Among them are the technical teams

of the National STD/AIDS and Teenage Health Coordination of the

Ministry of Health and the Brazilian representations of UNODC (United

Nations Office on Drugs and Crime) and UNAIDS, which together

with their determined leaders were essential as a means of moving this

project forward and achieving its goals. The names of all those who

were directly involved in project activities are duly mentioned in the

credits of this publication.

We would also like to thank the adults who occupy leading positions

in the institutions that support the young co-authors of this publication.

By placing their trust in the potential of this project and their willingness

to encourage various ideas, they have given considerable strength to

this initiative.

UNESCO BRAZIL Notebooks

YOUTH ACKNOWLEDGMENTS

I would like to thank Terezinha Pinto (APTA/SP) and Ézio Távora

of Rio de Janeiro’s Grupo Pela Vidda for being the ones who most

helped the group to mature.

Ana Beatriz

I would truly like to thank all my colleagues of the Youth WG to

which I belong, and also Dr. Paulo Teixeira, Suely Andrade, Vera Lopes

and Duda of the National Aids Program. From UNAIDS: Telva Bar-

ros, Nayara and Melissa. From UNESCO: Dr. Jorge Werthein, Maria

Dulce Borges, Cristina Raposo, Matias Spektor, Mariana Braga, Ana

Lúcia Guimarães, Lívia Gomes, Alexsandra Andrade and Roberta

Martins. From UNODC: Cíntia Freitas, Vera Da Ros, Etienne França.

Also Katia Guimarães, from the University of Brasilia, Luci Borges,

Ana Sudária and all those who directly or indirectly supported or helped

build the Youth WG on the road to the publication of this book. I

would also like to thank the BEM TV NGO which I represent and my

parents, who support and allow my work. Thank you very much.

Ana Paula

I thank those who idealized this project for their sensitivity in

understanding the importance of creating a Youth WG for the

formulation of Brazilian youth policies. I would especially like to thank

my great friends of the Youth WG, Cristina Raposo for the support she

gave me, Matias Spektor for conceiving the project, and all my UNESCO

friends for believing the dream to be possible. I would also like to thank

Terezinha Pinto and dedicate my contribution in this work to little Jurema,

for her fight and courage.

Daniel

I would like to thank the United Nations Agencies for the initiative

of this work and especially my UNESCO friends Cristina Raposo and

Matias Spektor. Thanks also to Suely Andrade and to ANDI, the News

Agency for the Children’s Rights.

Sérgio

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I would like to thank Helena Silva Jassen, Jorge Silva, Rodrigo Stufa

Gonzales and João de Deus Nascimento of the Movimento Nacional

de Meninos e Meninas de Rua. I would also like to thank Givanildo

Manuel da Silva, Lorival Nonato, of the Associação NovoOlhar, Asso-

ciação Cantareira and the Projeto Meninos(as) de Rua of São Bernardo

do Campo.

Elida

I thank my relatives, friends and students for their understanding,

and especially Elusa Gallo Rosenburg and Ricardo Castro Silva for their

work with Brazilian teenagers and youth.

Marco Antônio

The following deserve my deepest gratitude: first of all God, the

creator; my dear mother, Cícera Simão for understanding my thirst for

knowledge; my large Casa Grande family, especially Alemberg Quin-

dins and Rosiane Limaverde for the love and infinite wealth of knowledge

I gained by being with them. The friendly hands that supported me:

Matias Spektor, Socorro Acioli, Veet Vivarta, Suely Andrade, Teresinha

Pinto, Betinho, Cristina Raposo, Lívia and Vera Da Ros. Finally my friends

of the Youth Working Group: the understanding Daniel, the wonderful

Ana Beatriz, Sérgio the warrior, Élida the critical observer, Ana Paula

the star and the present poet Marco Antônio.

Mêires

UNESCO BRAZIL Notebooks

INTRODUCTION

“AIDS is transforming the life perspectives of human beings in the Third

World, turning their countries into barren lands. Brazil has demonstrated

that, armed with the power of competition, a government can do more than sit

and watch the desert expand.”

The New York Times, January 28, 2001.

Approximately one-third of the world’s population is between 10

and 24 years old, or more specifically, are youths. According to the World

Health Organization, half of the world’s HIV infections are concentrated

in this age range. This data indicates a critical situation and makes the

younger population an absolute priority in the public debate concerning

HIV/AIDS prevention policies in Brazil and abroad.

In the last few years, the search for broad answers to the problem

has made the international community insist that young people, whether

they are HIV carriers or not, be given the means to overcome the lack

of knowledge about HIV infection and prevention and to deal with

discrimination and the lack of resources regarding prevention and

treatment. Of course, these are all needs that developing countries share.

On the other hand, it has become clear that the best way to reduce the

incidence of the disease among young people is through prevention

networks conceived and run jointly by youths: the so-called “peer

groups.”

Throughout the world there are common obstacles that directly

affect the ability to find specific answers to HIV/AIDS for the young

sector of the population, both in terms of prevention and care. Whether

for geographical or cultural reasons, young people have less access to

information, services and resources than their adult counterparts.

The term “education among peers” refers to the work methodology developed and implemented

by people of the same population group, as, for example, teen to teen or woman to woman.

séries EDUCATION FOR HEALTH volume 1

Additionally, public and private health-care services are rarely prepared

to meet the specific needs of youth.

It is the belief of UNESCO that young people themselves can come

up with the strategies necessary to overcome the difficulties in preventing

HIV/AIDS. This can happen either in school or outside it, given that

they spend a good part of their time with people their own age. The

various forms of leisure available for the youth population and workplaces

where this group prevails are examples of venues that offer opportunities

for socialization and the sharing of attitudes and values.

Therefore, it is essential that decision-makers and public-policy

administrators at all levels are capable of grasping the perceptions of

youth concerning their present realities. This concept in turn leads to

the belief that AIDS prevention strategies should count on youth

participation in both the planning process and the implementation of

strategies. There is evidence that peer education leads to significant

behavioral changes among young people.

In addition, peer-promoted educational activities are particularly

important to youths in vulnerable situations, as they tend to trust their

“equals” more than they do adults, who are often perceived as figures

of authority.

Several professionals and organizations in Brazil are working to

develop HIV/AIDS prevention activities emphasizing the younger

population. Systematic and continued actions that favor the creation of

spaces for discussion and thoughts are associated with such organizations.

However, they all face the same challenges; namely the need to establish

priorities, exchange information and develop resources that help change

the characteristics of the epidemic for this population at the local and

national levels.

It is necessary to understand the feelings of those who intend to change

their behavior. In order to change one’s behavior, it is important to recognize

the object and attribute a value to it. It is exactly this value that will make it

easier for young people to adopt new attitudes and practices.

Therefore, it is insufficient for adults to simply recognize the

importance of prevention in the lives of young people and the factors

that make them so vulnerable. It is necessary that youths themselves

UNESCO BRAZIL Notebooks

recognize the significance and importance of prevention in their lives,

and this recognition being the motivating force for youth participation in

combating the HIV/AIDS epidemic.

“Youth participation basically relates to the preparation of solidarity

and citizenship. It concerns young people’s creative, constructive and

solidarity acts alongside people of the adult world (educators) in an

effort to find solutions for real problems in school, the community and

social life in a broader sense” (Costa 44).

Thus, young people become active participants in the creation of

their own environment by being the source of initiatives by taking on

commitments and especially through their ability to make choices.

It is an emergent fact that the engagement of the Brazilian

Government and organized civil society in youth-related matters results

from an augmentation in the information available about the situation

facing young people and consequently from the awareness of the need

to produce responsible citizens who are less affected by social and

economic disparities. However, teen-related policies have so far done

little to incorporate youths, who are the main beneficiaries of the

development of society in general.

Although programs and projects that include children and

adolescents in their various social agendas are generally more open to

include youth participation in their agendas, they still require the

appropriate support. In Brazil, the Child and Adolescent Statute (ECA)

entered political and social history as an example of a collective effort

by citizens, transforming children and adolescents into people with civil

rights and opening the doors towards solidarity and citizenship in this

phase of life. It became the job of the family, the state and society to

guarantee the rights described in the ECA which then classifies it as a

truly applicable resource.

This publication did not exempt itself, nor could it, from the

directives of the Child and Adolescent Statute. Therefore, all debate

and discussion within the Youth WG took place in consideration of the

rights of children and adolescents as contained in this document.

The texts presented herein were elaborated by members of the

Youth WG created within the UNAIDS thematic working group with

séries EDUCATION FOR HEALTH volume 1

the participation of the organizers of this publication. Technical experts

from UNESCO, the National AIDS Program of the Ministry of Health

of Brazil, UNODC, UNAIDS, the Public Health Study Nucleus of the

University of Brasilia, and the Child and Adolescent Health Area of the

Ministry of Health of Brazil all participated in the discussions and

contributed to the direction of the works, always taking into account

the perceptions and experiences of young people.

The present document intends to contribute to the formulation

and inclusion of policies specifically designed for young people regarding

the means of combating one of the present world’s greatest challenges:

the AIDS epidemic. The objective of this publication is not to close the

discussion on this subject, but instead to foster relevant thoughts and

discussions. Furthermore, it seeks to stimulate the necessary changes in

attitude and behavior among the general population, the media, opinion

makers and especially among young people who, in the real-world context

of transformations, must be the protagonists of their own destiny.

UNESCO BRAZIL Notebooks

UNAIDS THEMATIC WORKING GROUP

EFFORTS IN BRAZIL

The World Bank and seven United Nations agencies – UNESCO,

the United Nations Development Program (UNDP), UNFPA, UNODC,

the United Nations Children's Fund (UNICEF), the World Health

Organization (WHO) and more recently the International Labor

Organization (ILO) – have joined together in sponsoring UNAIDS, the

Joint United Nations Program on HIV/AIDS, as part of an effort to

gather AIDS prevention strategies from various UN organizations

worldwide.

UNAIDS implements its strategies in developing countries based

upon the participation of local teams of the seven UN agencies that

operate in the country and through their collaboration with other

organizations. The UNAIDS Thematic Working Group in Brazil

(UNAIDS WG) prioritizes the exchange of information as well as the

planning and monitoring of joint actions to combat HIV/AIDS. Its

composition differs from that of groups in other countries; besides the

representations of the United Nations agencies and the World Bank,

the initiative brings together other national and international institutions

from the government and the organized civil society.

The Brazilian Government, represented by the National AIDS

Program of the Ministry of Health, the Ministry of Education and the

Ministry of Foreign Relations, actively and decisively participates in the

UNAIDS WG, contributing to the creation of policies that involve

subsystems of planning, monitoring and evaluation in the preparation

of a national response to the challenge of HIV/AIDS.

Having just joined the Thematic Group, the organized civil society

contributes on the basis of its knowledge and experience, offering

proposals that make the work of the Group significantly more dynamic.

This subsequently provides Brazilian partners and the international

community with a clearer assessment of the nature and rhythm of

national initiatives put in place by the organized civil society.

séries EDUCATION FOR HEALTH volume 1

The National Business Council for HIV/AIDS Prevention is also

represented in the UNAIDS WG. The Council gathers together private

entities that are engaged in reversing the epidemic in the country, both

in the work environment and in the respective regions in which they

function economically.

The United Nations agencies contribute with their rich tradition

in research and pioneering projects, serving to improve the quality of

life for the population. The various agencies give young people, in the

context of their respective mandates, a differentiated treatment that

focuses on the different dimensions of this public's needs.

During the year 2000, while UNESCO was president of the

UNAIDS WG, this agency promoted the representation of young people

in the UNAIDS WG, believing it would contribute significantly to an

increase in the scope of what was being discussed by the team's

participants. Thus it contributed to the effort of Brazil to represent the

standard in combating the epidemic with the participation of the young

population in the Southern Hemisphere, the Americas and the rest of

the world.

The inclusion of the younger segment of the population has the

dual objectives of strengthening the local youth networks and including

issues that are pertinent to the dynamics and lifestyles of young people

in the programs implemented by the Brazilian Government, civil society

and international agencies.

Reasons for Having a Youth Working Group

Even if HIV/AIDS has not yet been registered as an epidemic in

the youth population of Brazil, it is critical that this group is not neglected

in the context of disseminating the dynamics of the Human

Immunodeficiency Virus (HIV) or the means of preventing it.

Sexual violence and the use of injected drugs, along with

unprotected sexual activity, have also made a significant increase in the

vulnerability of young people to HIV. In a country of such continental

dimensions and tremendous disparity as Brazil, the answer to the HIV/

AIDS epidemic in the youth population demands an intersectorial

UNESCO BRAZIL Notebooks

approach – namely health and education – that encompasses the three

spheres of the governmental structure (Executive, Legislative and Judi-

cial) and the organized civil society.

The networking between the various branches that focus on youth

in the context of the AIDS epidemic is an important step in

implementing a consolidated and efficient national system for combating

HIV/AIDS. Furthermore, the augmentation of related activities has

the potential to increase the awareness of the general population, and

of allowing experiences that were successful among young people and

those that they implemented to be replicated by other institutions and

communities with modifications according to their specific needs and

conditions.

Youth participation in HIV prevention activities therefore has a

number of advantages that cannot be ignored:

a) It preserves cultural and social diversity.

b) It stimulates discussions of young people's quality of life in the

broader context.

c) It promotes the inclusion of socially excluded youths (unemployed,

users of injected drugs, juvenile delinquents and others) in the

various discussions.

d) It stimulates thoughts about sexuality as a dimension of human

existence, promoting discussions about related themes (dating,

pregnancy, contraception and others) and creating a space for the

sharing of the experiences, doubts and worries that characterize

youth.

e) It has the potential to overcome gender inequality in all of its

manifestations.

f) It has the potential to help eliminate the stigma attached to those

who live in close contact with HIV/AIDS.

g) It stimulates the development of new approaches and concepts

that can be positively incorporated by governments, organizations

and entities that deal with the subject.

Several actions comprise the model of youth participation in

response to HIV/AIDS. These actions focus on giving young Brazilians

the necessary tools so that, together with their peers, they can modify

their local environment and consequently that of the nation.

séries EDUCATION FOR HEALTH volume 1

Bearing this in mind, the creation of the Youth WG contributes with:

• A discussion about education, health and quality of life among

young people.

• Answers to the effects of HIV/AIDS on the young population

which derive from their own perceptions and views of the world,

thus making them co-responsible for the control of this epidemic.

• Incentive for the effective provision of quality services in

healthcare and education.

• Support for actions that promote the use of condoms as well as

their distribution and sale.

About the Methodology used with the Youth Working

Group

The activities of the Youth WG were structured according to an

experiential and participative approach that dynamically integrates the

process of sharing experiences.

A) About the selection of group members

Members of the UNAIDS WG actively participated in suggesting

potential youth group members. Among the criteria established for

participation were regional representation, inclusion in the school

environment, insertion in the social movement, authorization of

custodians (for underage participants) and availability to travel.

The group was ultimately composed by seven members

representing different Brazilian administrative regions

and coming from

civil society organizations active in issues facing women, adolescents

and people living in contact with AIDS.

B)About the organization of the meetings

Meeting I – Brasilia, August 2000

Objective: allow group members to acquaint themselves and discuss

the efforts and roles to be developed.

2 See youth profile in the Biographies section.

UNESCO BRAZIL Notebooks

Activities: meeting for the presentation and familiarization of

participants; visit of the partners, discussion of the role of the

Youth WG.

Participants: UNAIDS, UNODC, National AIDS Program and

UNESCO technical experts.

Meeting II – Rio de Janeiro, October 2000

Objective: participate in the STD/AIDS Forum 2000 in Rio de

Janeiro; present the WG's work proposal in the said event;

Activities: participation of one of the members in the panel to

present the Youth WG's proposals and to stress the importance of

youth participation in combating the epidemic.

Participants: UNAIDS, UNODC, National AIDS Program and

UNESCO technical experts.

Meeting III – Rio de Janeiro, December 2000

Objective: participate in the UNAIDS meeting in Rio de Janeiro,

reconfigure the group's action strategy.

Activities: participation in the Program Coordinating Board (PCB)

meeting; thoughts and discussion of activities concerning the

extension of group actions; discussions of technical subjects.

Participants: UNAIDS, UNODC, National AIDS Program and

UNESCO technical experts.

Meeting IV – Brasilia, October 2001

Objectives: discuss the issues that will be incorporated in the

publication; coordinate the group's thoughts with regard to the

issues discussed.

Activities: dynamic activities for the re-integration of participants;

subject discussions; recording of discussions and recommendations

3 Refers to the UNAIDS Programme Coordinating Board meeting which took place on 14/15

December, 2000 at Rio de Janeiro. It concentrated on planning a unified global response to

HIV/AIDS. It reflected the important work of preparing for the United Nations General

Assembly Special Session on HIV/AIDS (UNGASS) and the planning done by UNAIDS

co-sponsors and by the Secretariat from the perspective of significant global initiatives in

response to the epidemic.

séries EDUCATION FOR HEALTH volume 1

for further systematization; discussion concerning the structure

of the publication.

Participants: UNAIDS, UNODC, National AIDS Program,

Adolescent Health Program of the Ministry of Health, and

UNESCO technical experts.

Meeting V – Brasilia, January 2002

Objectives: present the first draft of the publication based on the

data from the previous meeting; discuss issues with the participation

of other specialists; define a strategy of continuity on behalf of

the Youth WG actions.

Activities: theme discussions; group readings and considerations

about the publication draft.

Participants: UNAIDS, UNODC, the Public Health Study Nucleus

of the University of Brasilia, G3 Communicação

and UNESCO

technical experts.

As can be seen from the activities described above, the first three

meetings centered on participation in events with a regional and

national scope, intended to consolidate the role of young people in

Brazil's UNAIDS WG.

Supervised by technical experts from UNAIDS, UNODC, National

AIDS Program and UNESCO, the meetings were intended to familiari-

ze the participants with the educational practices used by each of the

youths in his or her community. Participants shared their experiences,

refined their perceptions and, in particular, discussed the participation

of young people in the national response to HIV.

Given the constant need for communication among participants,

the National AIDS Program of the Ministry of Health made available a

space on its website

and dedicated that space to the discussion and the

4 G3 Communicação is an advertising agency in Brasilia that was invited by UNESCO to clarify

matters concerning the advertising market, its relationship with the organized civil society

organizations and the subject of HIV/AIDS. This information helped the Youth WG base

its recommendations on the realities of the media market.

5 The NC STD/AIDS homepage is www.aids.gov.br, which is in turn a link to Adolesite.

UNESCO BRAZIL Notebooks

sharing of information: the Adolesite. Members of the Youth WG were

taught to access the Internet

and use the site.

From the fourth meeting onwards, work was conducted so as to

contribute to the organization of the ideas and thoughts of young people

regarding preventive education and the policies used to combat the

epidemic as expressed during the course of the discussions. This

organizational process fits in with the strategic perspective of

contributing, by means of a publication, to the implementation of

preventive actions based on the participation of youth as subjects of

personal experience.

A work schedule was thus established and organized over the course

of two meetings, having as its chief goal the elaboration of content and

the organization of thoughts and debates concerning the discussions.

The experiences shared by the group and the contribution of technical

experts during the meetings were analyzed and allowed for the

development of alternatives that might promote the understanding of

cross cutting issues within the HIV/AIDS epidemic. Among them are

the body, sexuality, gender and social control, among others.

The participation of the youths in this study was based upon how

they feel about, live with and view their realities. In this collective process,

the emphasis was given to the richness of individual differences among

the participants, the cultural diversity of their various regions and the

particularities of their work in the respective communities given the

different types of populations. However, of extreme relevance were the

personal aspects and abilities that contributed to the insertion of these

youths in the area of prevention.

This pedagogical stance provides the study with the legitimacy of

youth activism and of citizenship participation that together stimulate

the responsible development of autonomy. This legitimacy is affirmed

in the excerpts of the members of the Youth WG, which can be found

throughout this publication.

6 It is notable that not all the youths of the WG had computers in their homes or even easy

access to this resource, and that this disparity made more difficult the constant exchange of

information between group members and adolescents who were accessing the Adolesite.

séries EDUCATION FOR HEALTH volume 1

It is also in this sense that the experience contributes to the

development of actions directed toward preventing AIDS, sexually

transmitted diseases and drug abuse. This initiative of the UNAIDS WG

shows governmental authorities that the inclusion of young people in

discussions about the control and dissemination of HIV in Brazil can be

an extremely relevant resource in the formulation of public policies.

The proposals made by the youths therefore have the benefit of

working in favor of young people themselves, taking into account their

demands and needs in order to institute pragmatic policies and achieve

concrete results.

A Brief Overview of the HIV/AIDS Epidemic in Brazil

The AIDS epidemic has spread rapidly ever since the first AIDS

cases were diagnosed in the United States in 1980. It was not long before

cases were identified on the continents of Europe, Latin America and

Africa.

Although the HIV/AIDS epidemic reached Brazil with the same

epidemiological characteristics found elsewhere, in this country it

exhibited a particular scenario in which significant processes of social

change were taking place, namely rapid urbanization and the beginning

of the country's democratization. After the first registered case in 1982,

the epidemic grew at an alarming rate. By 1986, the country ranked

second worldwide in the number of registered cases with 790 AIDS

cases and 406 deaths (Daniel and Parker 33).

The Brazilian Government passed a decree in 1985 instituting the

creation of a National AIDS Program within the Ministry of Health.

However, it wasn't until 1986 that this new structure became active with

the development of a five-year plan to guide the Ministry of Health's

response to the epidemic up to the year 1991 (Ministry of Health,

Epidemiological Bulletin, 1987).

7 This term was applied retrospectively following the isolation of the human immunodeficiency

virus in 1984.

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From 1986 to 1993, the health-promotion acts developed by the

Ministry of Health to combat the AIDS epidemic were through means

of education and information. In 1987 and 1988, a large-scale education

program began to be implemented. Television, being a means of

communication that basically reaches all levels of society throughout

the regions of the country, thus became the main vehicle for national

campaigns of preventive education. Such campaigns also employed

information vehicles such as posters, leaflets and outdoor advertisements.

Several important measures were implemented in 1993 within the

National AIDS Program. Significant among these was the political

networking that took place with the scientific and research communities,

and with non-governmental organizations and community activists.

These measures favored the establishment of a cooperative climate

between the state and the organized civil society, thereby offering a

national response to the epidemic (Parker, 2000).

The experience obtained through this joint effort effectively

demonstrated that education and health promotion must be priorities

in order to achieve an intervention in the course of the epidemic.

The United Nations agencies and other international organizations

now recognize that preventive education is one of the most successful

strategies in combating the spread of HIV among populations.

The epidemic grew in Brazil until 1986. It stabilized from then

on until 1998 and in 1999, as a result of the national campaign, it

began to decline (Ministry of Health, Epidemiological Bulletin, June-

September, 2001). In 2001 there were a total of 222,348 registered

cases, with the Southeast region being responsible for 68.4%, the South

for 15.7%, the Northeast for 9%, the Midwest for 5% and the North

for 1%.

As for the participation of the state, the Ministry of Health

currently has the National AIDS Program that, together with state

and municipal programs, acts in the 27 states of the Federation and

in 150 municipalities that present 80 percent of the total number of

AIDS cases nationwide (Ministry of Health, The Brazilian Program,

2002).

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Changes in the Epidemic's Profile

Ever since the first known cases of the Acquired Immunodeficiency

Syndrome (AIDS) and its rapid and progressive dissemination through

various countries, the planet has been confronted with a complex set of

questions and perplexities that altered the pattern with which the

epidemic was initially presented.

The first epidemiological efforts took place in the United States to

understand and control the spread of the disease connected the HIV/

AIDS epidemic to the way of life of certain social groups that had

previously been stigmatized by the general society.

Initially homosexuals, followed by users of injected drugs and

prostitutes (the so-called "high-risk" groups) were believed to be the

most prone to infection. According to Mann, these facts outlined the

appearance of what he called the Epidemic of Social Reactions (Daniel

and Parker, 1991), in which prejudice and discrimination became the

standard response of different societies in response to the disease and

those directly affected by it.

Brazil's first AIDS cases were likewise related to male

homosexuality and the use of injected drugs. However, the profile has

changed as the epidemic has evolved. While the total registered AIDS

cases acquired through male homosexual relations corresponded to

36% of the total identified in the 80s and 90s, by 2001 the percentage

had fallen to 16.1%, whereas heterosexual transmissions had risen from

9.9% to 40% during the same period. The cases of transmission among

male users of injected drugs fell from 19.5% to 14.5% over the same

period.

Heterosexual transmission among the female population also grew

from 44.2% (accumulated cases until 1990) to 80.8% in 2001. The female

cases of transmission through the use of injected drugs plummeted

from 31.4% to 5.7% over the same period.

These figures show the most significant change in the profile of

the epidemic in which heterosexual transmission became the most

frequent form: the heterosexualization of the AIDS epidemic.

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Consequently along with this first metamorphosis a second one

took place; namely the feminization of the epidemic. While in 1990 the

male/female ratio of known cases was 7:1, in 2001 it was 1.8:1.

Another relevant aspect is the tendency to the "impoverishment"

of the epidemic. If one considers education as an indicator of this

tendency, it is clear that until 1982, 100 percent of the registered cases

among people with a known educational level consisted of those with a

university education or at least 11 years of education. Since then, the

situation has reversed. Nowadays over 60 percent of registered AIDS

cases are found in illiterate people or those with eight years or less of

education (Ministry of Health, The Brazilian Program, 2002).

Even though the world tendency of the epidemic points towards

its juvenilization, the data published in the Ministry of Health's

Epidemiological Bulletin shows that in Brazil, the proportional growth

of AIDS cases among 13-24 year olds is falling. Until 1990, 16.7% of

the cases were found in 13-24 year-olds, falling to 7.6% in 2001, while

among 30-39 year-olds the number of cases grew from 36.9% to 42.3%

during the same period.

Despite this downward trend, it is essential to point out that young

people prevail in the country's demographic profile (IBGE, Census,

2000). Thus, close attention must be paid to this age group in actions

designed to prevent HIV/AIDS. Furthermore, it is important to note

that the most affected population since the start of the epidemic is

between people of 25 and 29 years of age. Moreover, considering the

incubation period, it can be deduced that young people for the most

part are becoming infected between 15 and 25 years of age (Pimenta &

et al, 2001).

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AIDS AND VULNERABLE POPULATIONS

"Society as a whole has problems with sex, morals and death.

Whenever a disease touches on all three of these problems at

once, it is fatal. Whoever is afraid of sex, death, or has moral

problems regarding AIDS will therefore end up panicking."

Herbert de Souza, Betinho

As we saw in the discussion regarding the change in the

epidemiological profile, the emergence of the AIDS epidemic was

marked by its connection to groups considered to be at risk. This in

turn led to an increase in the prejudice and discriminative attitudes

regarding such groups.

During the second phase of the epidemic, the focus of HIV/AIDS

dissemination was turned towards individual behavior, and individuals

became seen as responsible for their own exposure to the risk of HIV.

It was only later when knowledge of the HIV infection process had

matured and the propagation of the virus became explosive that it

became clear that other factors had a decisive influence on people's

behavior.

Other segments of society began to be affected without it being

possible to connect them to the initial groups. It was also noted that

their behavior patterns differed from those previously thought of as

risky. An example of this was the feminization of the epidemic in which

manifestations of cases among females began to accelerate. At the same

time, cases also appeared in other stigmatized groups, such as the

incarcerated population. The epidemic had reached the less-favored layers

of the population.

This new context revealed the social dimensions of the epidemic

and led to the reconsideration of strategies previously employed to combat

it. The concept of vulnerability began to be used in an effort to understand

the factors implicit in the dynamics of HIV propagation.

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Three levels of vulnerability were identified in this new perspective:

individual, social and programmatic. Individual vulnerability is linked to

people's access to AIDS-related information, the quality of such

information and the capacity to develop on and work with it so as to

transform their knowledge into practical actions for daily life.

Regarding social vulnerability, it was clear that the capacity to

undertake this transformation depends not only on individuals but also

on other aspects such as access to quality education and health care, the

availability of material resources (income) and the possibility of facing

cultural barriers. Programmatic vulnerability refers to the difficulty in

accessing programs and resources capable of minimizing or eliminating

the factors of individual and social vulnerability.

Thus, the National AIDS Program considers the stigmatized

populations to be most vulnerable due to their effective exclusion as a

result of stigmatization. Groups such as male homosexuals and sex

workers, among others, therefore receive special attention through

specific programs.

Because adolescents do not always have sufficient access to age-

appropriate information, and because their possibility of obtaining prevention

supplies is made relatively more difficult by cultural barriers and the lack of

material resources, a special program has been created for them.

Bearing in mind the prejudices brought out by stigmatization, in

order to enhance the efficiency of prevention actions, another relevant

aspect is the application of the concept of vulnerability

to the

understanding of the epidemic. This application must incorporate the

structures of social exclusion in the context of the virus' dissemination.

More than ever, this reaffirms the need to view this subject in light of

human rights, and thus to create an opportunity for an ethical debate

regarding those infected and affected by HIV/AIDS.

8 From an epidemiological, behavioral and demographic point of view, the populations listed

below have priority in the national policy: Children and adolescents; Poor populations;

People who live with AIDS; Men who have sex with men; Users of injected drugs; Sex

workers; Indigenous communities; Truck drivers; Confined populations; Members of the

Armed Forces; Women and mother/child transmission (as taken from The Experience of

the Brazilian AIDS Program, 2002. Brasilia DF).

9 The concept of vulnerability is defined in the glossary at the end of this publication.

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Recommendations

Offer awareness training in adolescence, sexuality, STD/AIDS

and drug abuse according to socio-educational measures to professionals

dealing with teenagers.

• Encourage the organization of HIV-vulnerable populations so

that the practice of citizenship contributes to their inclusion and

to the formulation of efforts directed toward this sector of the

general public.

• Encourage the participation of vulnerable populations in the

creation and distribution of educational and preventive materials.

• Make information available regarding the right of access to public

healthcare and education services.

• Guarantee the discussion of homosexuality in school orientation

programs.

Within those stigmas, there are labels attached to prostitution . . . that are not

of prostitution itself, they're external, because it is people from outside who sell

things to those houses that work as . . . brothels and things.

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AIDS AND DRUGS

"The most complex problems can be solved with pretty simple

solutions: humanism, solidarity, compassion and wisdom."

Volunteer, Federal District

To speak about drugs is to touch on matters that are still too

sensitive and ambiguous within society at large. Despite the frightening

images commonly associated with illicit substances, there is a complacent

attitude in place due to so-called "legal" drugs such as tobacco, alcohol

and several types of psychoactive drugs.

The control of these illicit drugs was for a long time almost

exclusively in the hands of the police with minimal participation from

public health agencies.

Starting in the mid-80s, the growing debate concerning the

problems resulting from legal drug use started to reduce the prejudice

and cause a gradual shift of health-related matters to the subject.

However, drugs are nowadays very much associated with trafficking

and violence which is why their control is frequently associated with the

formulation of public safety policies. Nevertheless, the marginalization

imposed on drug addicts challenges their access to public healthcare

services and to their basic rights as citizens, making them more vulnerable

and further encouraging their involvement with crime. In this sense, it

is essential to make a distinction between trafficking, subject to legal

control, and drug abuse, which is more accurately identified as a health

issue.

10 Alcohol is the drug responsible for the most hospital stays related to dependency

and other diseases such as cirrhosis of the liver, occupying fourth place in the

diseases that most incapacitate people in our country (SUS, Ministry of Health).

In 1996 the Hospital Internment System of the Unified Health System (SIH/

SUS) registered that alcoholic liver cirrhosis was the seventh greatest cause of

death in the population over 15 years old.

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According to data from the Ministry of Health, approximately 25

percent of registered AIDS cases are either directly or indirectly related

to the use of injected drugs; 52 percent of Brazil's injected-drug users

(IDUs) are HIV carriers; 38 percent of women with AIDS contracted

the virus by sharing needles or through sexual contact with IDU partners;

and 36 percent of pediatric AIDS cases point to the mother or her

sexual partner as being an IDU (Ministry of Health, National AIDS

Program, 2001).

It is clear that drug abuse can lead to infection with the AIDS

virus and other diseases, given the fact that users frequently engage in

unsafe practices such as unprotected sex or the sharing of needles or

other utensils capable of transmitting diseases.

Although experimenting with drugs does not always lead to

dependency, the fact that the use is occasional or recreational does not

diminish its potential risk. Therefore, it is now considered essential to

include drug abuse as an HIV vulnerability factor when discussing the

drug phenomenon.

It is important to note that users play an important role in initiatives

relating to harm reduction,

meaning those initiatives that aim to promote

attitudes of prevention regarding AIDS and other diseases among users

themselves and the people who live in contact with them.

Recommendations

• Seek the participation of young people in the formulation of drug

abuse prevention policies and the care of addicts.

11 Starting from the premise that drug-dependent individuals have difficulty

interrupting substance abuse, harm-reduction strategies include the following:

respecting the user's condition without stimulating drug use; promoting the

non-injected use of drugs; guaranteeing that needles and other devices employed

in drug use are not shared.

12 By the Group's suggestion the recommendations made for the subject "AIDS

and Preventive Education in the School Context" are perfectly adaptable to

the subject "AIDS and Drugs." So as not to become repetitive, the youths

therefore preferred to add this note to suggest the reading of the previous

subject and use of its recommendations.

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• Consider the promotion of one's quality of life instead of the

cliché, "Just say no to drugs," in prevention programs.

• Stimulate preventive approaches that are oriented toward the

perception of the user's vulnerability.

• Encourage the networking between health, education and civil-

society organizations and services both in preventing drug abuse

and caring for addicts.

• Increase the knowledge of harm-reduction actions so as to

encourage a health policy that favors the strategy.

• Guarantee that the Unified Health System (SUS) will care for drug

users and addicts along with their social networks.

• Suppress any words that have a connotation of war or violence in

slogans about the subject. Examples: combat, war, against.

Now beer, alcohol is horrible stuff, it makes you sick . . . . That pleasure

needs limits if you don't want to take any risks. It's just like sexual pleasure, in

which the limit is the use of condoms so you don't risk anything. So, you see, the

line between pleasure and risk is very thin.

It isn't just a matter of walking up to a teenager and saying "don't use drugs,"

but rather working with him so he realizes that a healthy life can be really neat; that

you can live longer, be better, get along with other people better . . . .

I think what often takes young people of the higher classes to enter the world

of drugs is the family's lack of affection. At the same time that they have everything,

they don't have the main thing, which is affection.

This thing of words: we're always talking of the war against drugs, the war

against AIDS. It would be nice if we could rethink this "war" thing.

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AIDS AND THE ADOPTION OF PREVENTIVE

PRACTICES

"No dichotomy is capable of explaining us. We are neither simply

what we acquire nor what we inherit.

At this point we represent the tense relationship between what we

have inherited and what we have acquired.

We are bodies or beings programmed but not determined."

Paulo Freire, Educator

The creation of favorable and unfavorable attitudes towards health

begins in childhood during the process of forming and integrating the

individual in society. The main goal in STD/AIDS prevention is the

development of a critical conscience that favors the use of attitudes

and practices that avoid infection and consequently stop the progress

of the epidemic. Thus it is important that any effort directed toward the

change in sexual attitudes and behavior take into consideration the

symbolic meaning of preventive measures, as these are directly related

to the social-cultural context of the individual.

Each of us is vulnerable to HIV infection at the biological level: if

exposed to the virus through sexual contact or blood, apparently anyone

can become HIV-positive. If an innate or biological resistance to HIV

infection exists, it has not yet been discovered. However, HIV needs

specific and identified paths for transmission to occur: unprotected se-

xual practices, needle sharing, contaminated blood transfusion or mother-

child transmission (Mann, 1991).

However, the conclusion was reached that a person acts and

manifests his will in the sphere of social interactions and that particular

behavior is therefore not only determined by personal will but is strongly

conditioned by the collective environment.

The direction of the epidemic's evolution, leaving the initially

affected groups (the so-called high-risk groups) and expanding toward

all segments of society--in particular the poorest-- showed that the

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epidemic must be considered from a broader perspective. This means

that the change toward protective behavior in AIDS prevention is not

necessarily the result of "information + willpower." It is also necessary

to consider such cultural aspects as gender and economic inequality,

these being life conditions.

The explosion of the epidemic toward the poor, women,

marginalized populations, Negroes and youths of Brazil – the so-called

"impoverishment" of the epidemic – demonstrated that HIV/AIDS is

reaching segments that have poorer access to information, education,

health care and social services.

In the case of the HIV epidemic, the adoption of the use of

condoms is the optimum behavior, this being the only confirmed efficient

barrier against sexual HIV transmission and sexually transmitted diseases

(STDs). The study "Sexual Behavior in the Brazilian Population and the

HIV Risk Perception" (Berquó, E. et al, 1999) revealed that in a sample

of 3,600 individuals ranging from 16 to 65 years of age, among which

80 percent are sexually active, 64% declared having used condoms during

the last 12 months. Among young people this percentage reached 87

percent.

Although the numbers suggest a high adherence to the use of

condoms, young Brazilians still find it extremely difficult to access this

resource because since they are poorer and younger, they have less money

to obtain them. Moreover, even when they do have money to buy

condoms, they still have to face taboos regarding the exercise of their

sexuality which makes them more vulnerable to HIV exposure.

The efforts undertaken especially by the Public Health Network

through programs destined for adolescents work as a way of reducing

this vulnerability, particularly regarding the distribution of condoms.

Given that they're in their formative years, young people have a

greater capacity to learn and adopt protective attitudes and practices

concerning their own health. It is essential that the programs developed

and implemented in schools with the participation of adolescents and

educators promote self-esteem and stimulate young people to take care

of their health. They should further enhance their decision-making power

and develop their capacity to find answers to life's problems.

UNESCO BRAZIL Notebooks

Recommendations

• Promote the universal dissemination of knowledge about HIV

prevention, forms of infection and available care so as to make

behavioral changes possible.

• Use the media as a facilitator for behavioral changes.

• Make access to prevention supplies easier so as to foster behavioral

changes.

• Render information available about anti-retroviral (ARV) therapy

so that medication does not serve as a justification for the non-

use of condoms.

• Organize debates about unprotected sex.

• Promote strategies that encourage responsible sexual attitudes and

behaviors.

• Educate young people to care for people with AIDS in the family

and in the community.

Speaking of taboos, we still have a lot of them nowadays. In my time, when I

started getting my period, we used to hear the boys commenting that if a girl was

walking with her legs open it was because she wasn't a virgin anymore.

I think if he has access to them (condoms), at least he'll try . . . .

It would be interesting if young people got used to always walking around with

condoms before starting their sex lives, don't you think? A girl would carry one in

her purse as if it were the most normal thing in the world, like a lipstick or something…

But without that mandatory connection, like, "If you have a condom with you it's

because you're going to have sex tonight."

You can't wait until the guy's 18, or I think even before that. I think if the

parents were to . . . leave a condom on the table, you know? And the kid went,

"What's that?" and the parent said, "Oh, it's a thing you're going to use..."

People don't worry about each other or about affection anymore. They're always

more worried about material things.

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AIDS AND PREVENTIVE EDUCATION IN

THE SCHOOL CONTEXT

"Young people need to make their voices heard, like the main actors

in the future of our planet."

Koffi A. Annan,

General Secretary of the United Nations

It is the school's role to contribute so that health can be

understood as a universal right and an essential dimension of human

development. In a country of endless social and economic diversity,

issues of health are directly related to educational aspects. The school

needs to reflect the needs of society, because it's essential that issues

relating to the daily lives of students are brought up. Therefore, health

education has the role of guiding young people and making them

conscious of their right to health, in addition to inducing them to use

preventive practices.

One of the most important initiatives of the Ministry of Health in

recent years was the creation of the National Curriculum Parameters

(PCN) for pre-school, primary, secondary and indigenous education.

These parameters are not meant as a compulsory model for the creation

of curriculums but are meant to serve as references in the effort to

organize Brazilian education.

PCNs demonstrate the need to treat the subjects in a crosscutting

manner so as to integrate the social problems that are part of the Brazilian

reality by permeating the content in each area throughout the school

years. Among them, subjects such as health and sex education, for

example, speak directly to the urgent need to consolidate AIDS

prevention efforts.

Behavioral change through education has been one of the essential

strategies in the containment of the advance of the AIDS epidemic and

other sexually transmitted diseases in Brazil. In that sense, during its

normal course, school is a privileged space for the implementation of

preventive actions.

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As established by the PCN, in order to develop STD/AIDS

prevention activities, it is essential that the approach used is not

separated from issues relating to the human body or sexuality, nor

from the cultural, racial and religious diversity that permeates human

existence.

Sexual education must be based upon a broad vision of sexuality

and upon the principles of autonomy, dignity, solidarity, respect, tolerance

and family and community life.

Recommendations

• Develop strategic planning in schools so as to establish

institutional responsibilities with the participation of parents,

students, teachers, employees and partner institutions.

• Stimulate the community's social control of the activities,

attributions and rights of the school community.

• Include the participation of young students in the process of

developing school curriculums and consider the insertion of

crosscutting issues indicated by the PCNs.

• Include the participation of young people in the planning,

monitoring and evaluation of prevention activities in

schools.

• Contribute so that educational materials destined for use by

adolescents have adequate language and are accessible to that

segment of the population.

• Include the participation of adolescents in the development,

construction and choice of pedagogical materials.

• Make sure that the responsibility for activities designed to prevent

STD/AIDS and drug abuse are not solely in the teachers' hands,

and thereby promote the participation of adolescents in the

dissemination of preventive information.

• Train educators to use strategies that deal with self-esteem,

pleasure, sexuality and STD/AIDS in a coherent, integrated

manner.

• Ensure that schools contribute to validate the role of adolescents

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as 'multipliers' (volunteers that provide information about a relevant

subject) and thereby allow them to develop their work either formally

or informally to initiate discussions about the subject.

• Promote the creation and strengthening of student bodies within

schools as a means of stimulating autonomous and citizen

participation in HIV/AIDS-related matters.

• Strengthen the role of the Guidance Counseling Service according

to the definition of its attributions.

• Create a school environment that fosters the continuous

development of activities relating to these subjects.

• Sensitize, mobilize and instrumentalize school directors regarding

the need to develop efforts relating to sexual and reproductive

health, sexual rights and drug abuse in schools.

• Stimulate the development of partnerships between schools and

civil society organizations concerning:

o The formulation of a pedagogical and curricular proposal

o Information about services

o Participation in prevention-related activities

o Methodology in prevention work

o Exchange of information

o Strengthening the ties of schools with governmental

institutions that act with adolescents such as the Tutelage

Council, healthcare services and others.

• Promote and stimulate research about the Child and Adolescent

Statute so as to debate and understand the concepts and

recommendations it contains.

• Stimulate the insertion of young people in the Tutelage councils,

municipal councils and in state and national councils dedicated to

the rights of children and adolescents.

• Concerning condoms:

o Develop activities for parents, teachers and school

employees that foster an understanding about the

importance of using condoms.

o Develop continuous activities that give information about

condoms in all grades including elementary school.

o Systematize and formalize the teaching of condom use in

the pedagogical proposals of schools.

o Make condoms available in schools.

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• Develop a supportive school environment so as to receive HIV-

infected students, professionals and parents and guarantee their

rights through an egalitarian approach.

• Welcome teenage parents and pregnant teenagers to ensure that

their school performance is affected as little as possible.

"Adolescent multipliers" are those that hang around in the halls and

bathrooms every day, speaking to other kids. There is informal 'multiplication',

and then there's the formal kind when you get into groups, supervise people, etc.

See, sometimes only the formal kind is considered to 'multiply' (or teach) while the

informal kind of talking in the halls, in schools or bars is not necessarily considered

really multiplying, you know? Maybe that's it. Maybe it's a matter of identification,

of formalization...

Then there are the teachers who have doubts. They have a bunch of doubts

and difficulties in matters of sexuality. One of our greatest difficulties at events is

to include teachers . . . . We used to do that, you know? Because there were groups

in the rooms and we wanted to include one of the teachers to be there with us but

they totally refused because of a series of social problems and difficulties about the

whole thing...

You know what? My best friend used to be my biology teacher. She was the

one who explained some things to me that I never had the courage to ask my

mother. She clarified things for me...

I think that's what we need: a discussion space. It isn't just a matter of the

teacher standing there and explaining. We need a space where the teacher will feel

at ease to speak out. That's what I feel, you know?

13 This recommendation was not a consensus among all members of the Youth WG. All of

them, however, agreed that it is essential that if schools do decide to make condoms available,

they should promote a deep discussion of values and the exercise of sexuality so that condoms

are understood as indispensable preventive supplies for the maintenance of sexual health.

Some members of the Youth WG argue that in the Northeast, for example, cultural reasons

would make it very complicated to make condoms available for various reasons: 1. Parents

may understand this as an incentive for young people to begin their sex lives. 2. Teachers do

not have adequate training and often don't have enough information to deal with their students'

doubts. 3. Young people may feel embarrassed to ask for condoms in the school environment.

Despite these considerations, the WG chose to include this recommendation so as to contribute

toward the debate within the scope of educational policies.

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If schools stimulated student bodies, discussions with other student bodies--if

they did more things like that--we would have fewer vandalized schools, we would

collect more supplies, and students would use their schooling better. I think a lot of

things could change.

We also tend to criticize schools and say they don't open any space. Sometimes

they even do, but sometimes, because of limitations, they don't manage to, because

there isn't any teacher willing to . . . .

The school can be a space to build ideas. I think the school needs to be a space

where you can take subjects you can discuss with the family, you know? I think there

should be a globalization of knowledge, an understanding of what homosexuality is

in order to design strategies that have a clearer notion of the goals. Everyone has a

right to his own sexuality; to his sexual orientation. Each person should know for

himself where he is going to find his erotic pleasure. But if he's going to be taking

risks, at least let there be no risk of contracting HIV.

Sometimes adults come with pre-established, ready-made agendas. They'll come

in and say something like, "All right, let's talk about condoms." But sometimes that

isn't what we want to talk about first. We want to talk about kissing, holding

hands, making out, what happens when I like a boy, how should I act or react, values

. . . .

The question of subjects is very complicated. Before you speak of AIDS or

sexuality, there are many other subjects that also deserve attention; that are necessary

before we get there.

I think we need to deal with it differently because of parents. If you put a

condom machine in the middle of a high school without preparing students or

professionals, you're asking for trouble.

Information needs to be continuous through every grade, and it needs to start

now. If you start now and give out information from fifth to eighth grade, at some

point in the future they'll be ready for the condom machine in school.

I don't know, I think that before bringing in the condom machine there needs

to be a preparation. It needs to be worked on.

What kind of work, Daniel?

Workshops . . . .

Workshops with whom? Young people?

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With young people, teachers [laughter]. Otherwise the machine's just gonna stay

there, the students are gonna pass by and aren't gonna take any. They'll be too ashamed.

The guys might, but what about the girls?

Girls need them too, see?

UNESCO BRAZIL Notebooks

AIDS AND WORK

"Young people play an important role in the process of change.

They bring renewal but suffer with the new requirements that keep

them away from the job market. A lot of hope is placed on the

shoulders of young people, but one must recognize that theirs is a

hard road to travel and that they must be integrated in society."

Ruth Cardoso,

President of the Solidarity Community Council

The HIV/AIDS epidemic is deeply affecting social, cultural and

economic structures. It represents a serious menace to the working world

because of the way it affects the work force, imposes high costs on

businesses in all areas, reduces productivity, increases work costs and

results in the loss of capability and experience. Estimates of the ILO

indicate that at least 25 million workers worldwide between the ages of

15 and 49 are currently infected with HIV.

Faced with these statistics, the National STD/AIDS Coordination

has been promoting efforts regarding the epidemic in the workplace. In

October 1998, the Ministry of Health published a decree creating the

National Business Council of HIV/AIDS Prevention in the Workplace

(CEN). The goal of the Council is to support the national response to

the epidemic and to launch campaigns that foster awareness, mobilization

and the spread of information regarding AIDS prevention and the

promotion of health in businesses.

Recognizing that HIV/AIDS is a problem that also affects the

workplace, the ILO created the "ILO Program on HIV/AIDS and the

World of Work" in November 2000. The goal is to contribute toward

the containment of the pandemic by organizing information concerning

its impact on the working world, combating discrimination and exclusion,

developing awareness campaigns and giving advice to its members.

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One of the first activities of the ILO program was the production

of a "Code of Practice on HIV/AIDS and the World of Work," which

was created in partnership with governments, employers and employees.

The code was launched by the general director of the ILO in a Special

United Nations Session on HIV/AIDS held in New York in June 2001.

This document stimulates prevention and care for workers and their

families.

Based upon the ILO's basic principles of protecting workers' rights,

promoting employment, protecting society and encouraging social dia-

logue, the document covers subjects such as prevention, training, anti-

HIV testing and confidentiality, and the care and support of HIV infected

and affected workers. They are:

1. Recognition of HIV/AIDS as an issue in the workplace.

2. Non-discrimination and stigmatization of people living with HIV/

AIDS.

3. Promotion of gender equality.

4. The healthy and safe environment in the workplace.

5. Promotion of social dialogue to establish joint programs and

actions between governments, employers and employees.

6. Prohibition of HIV screening for job applicants or employees.

7. Guarantee of confidentiality on HIV/AIDS-related information

of applicants and workers.

8. Maintaining the employment relationship.

9. The development of prevention efforts.

10. Guarantee of care and support for workers and their families.

Recommendations

Promote information about biological, psychological and social-

cultural matters that involve AIDS so as to prepare businesses or

workplaces to:

14 The Portuguese version of the Practice Code was launched in May of 2001 in São Paulo by

the National STD/Aids Coordination, and by the ILO with the support of various entities

dealing with the subject. On that occasion, several proposals were elaborated for

implementation of the code in Brazil.

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• Recognize that AIDS is a problem in the workplace just like any

other disease.

• Refrain from the HIV screening of job applicants or effective

employees.

• Guarantee a work policy that respects human rights.

• Ensure that HIV and its treatment do not constitute grounds for

dismissal.

• Facilitate the development of continuous and systematic

prevention activities in the workplace.

• Develop solidarity within a work environment that is free from

discrimination.

• Foster discussions about the importance of HIV testing among

workers instead of making it mandatory.

In cities like São Paulo and Rio de Janeiro, being young and getting your first

job is very difficult. If you don't get your first job, then you don't get any experience,

but without experience you don't get a job. This makes for a very complicated vicious

circle, and then when AIDS gets into the picture...

How can businesses be educators? Because they're in it for a profit.

But it's really interesting because the numbers say a lot. It's what the Ministry

of Health does to justify the AIDS program. It says, "Yes, we're spending US$300

million, but if the program didn't exist we'd be spending US$900 million in treatment

costs. So in the end we're saving money." So, because businesses think in terms of

profit, this may be a strategy.

It wasn't necessarily to label people who worked there but to show that among

all the other health problems such as diabetes and high blood pressure there was also

AIDS.

Our society is becoming more and more competitive. If you don't have the

ability to deal with that competition you're out, and if you're out you're looking for

a way in. It isn't only about professional education. Just look at how many kids

finish college but don't find jobs.

That's not the point. There are other abilities: negotiating power, networking,

a broader vision of life and things like that.

UNESCO BRAZIL Notebooks

AIDS AND THE MEDIA

"If I'm not satisfied with a scene, we shoot it again. But with AIDS

the movie ends.

Breaking the silence depends on you and me."

Danny Glover, movie actor.

The media has acquired a considerable influence in the lives of

children and adolescents. But despite having control of the content in

each area of communication, professionals in the area still have trouble

dealing with subjects that relate to sexuality in adolescence, whether for

personal reasons or because of the scope available for the subject in the

media.

According to the document "Os Jovens na Mídia," "The media

has a great power of influence on the creation, diffusion and maintenance

of behavioral models ( . . . )" (Ministry of Health, 2000). Subjects such

as the need to assume and/or difficulty in assuming a greater

responsibility in the practice of safer sex and the consequences of teenage

pregnancies are starting to be permeated in the emerging Brazilian me-

dia.

An analysis made by ANDI (The News Agency for the Rights of

Children) during the year 2000 and published by the Mídia dos Jovens

magazine shows that more than 85 percent of the youth-related news

reports analyzed centered on the use of condoms and AIDS-related

matters. Newspapers and magazines have been proved to contain a

considerable amount of HIV prevention information in articles about

sexuality and pregnancy, demonstrating a tendency toward the

dissemination of AIDS-associated issues in the Brazilian media.

Thus, the media plays a critical role in disseminating AIDS-related

information. By reaching populations economically and socially favored,

as well as those less favored, the media acts as a co-agent of social

transformation and is at the same time responsible for the information

it makes available. Radio, TV, newspapers and magazines can serve as

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allies in the strategies to respond to the epidemic. It is important that

the messages be gradually adapted to each vehicle so as to reach the

target populations.

Recommendations

• Promote the use of the radio as an excellent, low-cost vehicle for

the dissemination of prevention messages to young people.

• Demonstrate the wide reach of radio and stimulate the youth

population to promote prevention messages in the medium.

• Encourage the transmission of prevention messages in community

radio and TV broadcasts.

• Compare the advantages between the various means of

communication so that young people can promote prevention

messages that are adequate to their goals and possibilities.

• Foster discussions about the quality of radio, TV, newspapers and

magazines in schools, stimulating the creation of a critical point

of view.

• Encourage the media and advertising agencies to associate the

products consumed by young people with healthy behavior.

• Look for incentives for the creation of alternative newspapers

dedicated to prevention in specific populations of the private sector

(small and large businesses).

• Train media professionals to deal with subjects related to AIDS

and young people.

• Stimulate the media to adopt an editorial stance that incorporates

STD/AIDS prevention.

• Develop guidelines directed towards the different segments of

the public, centering on preventive education and focusing on a

critical approach to STD/AIDS and drug abuse.

• Support the growing inclusion of subjects such as preventive

STD/AIDS education and pregnancy in adolescence in TV

programs directed toward the young or low-schooled population.

• Have the media transmit the need to apply the Child and

Adolescent Statute.

Television, for example, is a communication vehicle that reaches all segments

of the public simultaneously. We really have to do something that reaches both the

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more enlightened population and the less favored ones. So, I think it's going to be

hard to use just one campaign.

Of course, campaigns are efficient in reaching young people, but nowadays to

reach them I think art should be the main instrument, you see? Music, theater, you

know? All those things...

"If self-esteem is connected to many other points... young people will have the

power to resist being manipulated by the media. It's like I said: having a critical eye

for everything."

UNESCO BRAZIL Notebooks

AIDS AND YOUNG HIV CARRIERS

I learned two things with AIDS: the meaning of prejudice . . . and

of solidarity."

Publication: Leticia e Daniel, Falando Sobre AIDS

The greatest breakthrough in the context of HIV/AIDS prevention

and public health was the realization that there was a need to confront

the discrimination against those infected by the virus or people living in

close contact with them. The inclusion and active participation of these

people in the augmentation and implementation of public policies,

programs and efforts destined to halt the worldwide growth of the

epidemic thus became critically important. Discrimination was identified

as a tragic and counterproductive effect of the pandemic.

The efficiency of this breakthrough has been systematically

reaffirmed during the two decades of the epidemic in Brazil. In

activities developed through government programs, continued

intervention and prevention efforts undertaken by civil society

organizations, seminars and conferences promoted by different

teaching areas, as well as the speeches and workshops implemented by

private organizations, the participation of people living with HIV/

AIDS have been extremely important in demystifying the disease and

overcoming the prejudice that has continually marked the lives of the

people affected by the disease.

Today in the year 2000, more than 20 years since the emergence of

the HIV/AIDS epidemic, it is possible to say that a great evolution has

occurred, particularly one of technology. Time has seen the development

of medications and the utilization of therapies that in most cases do

not allow the replication of HIV or the installation of opportunistic

disease in the human body and that avoid the vertical transmission of

the virus.

séries EDUCATION FOR HEALTH volume 1

To date there is no cure for AIDS, nor is there a way to remove the

HIV virus from the human body. However, we are living in a new era of

the epidemic.

Considering the incentives given to the effective participation of

young people in confronting the AIDS epidemic and the incentives in

formulating strategies to stimulate this segment of the population to

exercise its right of citizenship, the inclusion of young HIV carriers in

such efforts becomes fundamentally important.

Even if we have managed to promote a greater awareness

concerning the negative effects of discrimination and the exclusion of

those living in contact with HIV/AIDS, prejudiced reactions still persist

in common society. Today we live in contact with the first generation of

young people to be infected or affected by HIV.

The inclusion of young HIV carriers in programs directed toward

the strengthening of youth participation may lead to the elimination of

any prejudice that still exists and facilitate the discussion of affectivity

and sexuality in this new era of AIDS awareness.

In addition, this thought also reinforces the need to adopt safe

sexual practices so as to avoid not only STD/AIDS but also unplanned

pregnancies. This is particularly true in Brazil where the statistics are

very high.

Recommendations

• Include young HIV carriers in the school environment and

guarantee their right to remain.

• Guarantee young HIV carriers their right to secrecy.

• Stimulate research about the behavior of young HIV carriers in

the sense of supporting the formulation of efforts and policies

for this group.

• Encourage the adoption of AIDS orphans and/or young HIV

carriers.

• Foster specific health programs for young HIV carriers so as to:

o Stimulate the use of ARV therapy.

o Offer psychological, social and legal advice for young people

and their families.

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o Guarantee the inclusion and continual participation of HIV

infected children and adolescents in social programs

developed by civil society and the government.

o Foster the creation of a "first job" program for young HIV

carriers with incentives from the private sector.

o Help young people with HIV to develop abilities to deal

with the daily situations faced by their condition.

Young HIV carriers should be recognized at their jobs in order to maintain a

policy of respect for human rights. Businesses should keep this in mind and train

people to prepare to live with diversity . . . .

A friend of mine used to say the following: A girl is going to sleep with you

depending on how you treat her. If it's a passionate relationship she'll do it without

a condom. But if she gets involved, we need to think about that . . . .

Passion is an element that sweeps condoms out of the picture. When you add

passion to the cycle of sexual response, it gets even more complicated to negotiate the

condom.

UNESCO BRAZIL Notebooks

CONCLUSIONS

According to data up to the end of 2000, 36.1 million people

throughout the world now have AIDS with 90 percent of them living

in developing countries. The world epidemic affects rich and poor

without respect to age, sex or race. However, it is important to note

that women, young people and children, especially girls, comprise

of the most vulnerable groups. For this reason, there is a global

consensus that the HIV/AIDS pandemic constitutes a global

emergency. It is an emergency that stands as one of the greatest

challenges to humanity, especially with regard to the human rights

of citizens worldwide. Moreover, AIDS is considered one of the

main obstacles in the social and economic growth and development

of different continents, and as such, it has great consequences for

nations and individuals alike.

UNAIDS recently announced that the number of AIDS-related

deaths in the year 2000 in Brazil was one-third the number registered

in 1996. In the same report, which was published the week before

the Barcelona Conference (7 to 12 July, 2002), a decidedly

unoptimistic piece of information led to an observation: AIDS is

expected to cause the death of 65 million people before 2020, a

number that exceeds three times the number of deaths registered in

the first 20 years of the epidemic. Brazil has demonstrated that it is

working in the right direction, and its efforts have brought great

benefits for the Brazilian society and most of all served as an example

to the world.

The Twenty-Sixth Special Session of the United Nations General

Assembly on HIV/AIDS (UNGASS) was held in New York in June of

2001. The chiefs of state and government and representatives of states,

governments and the organized civil society from various different

countries in the world gathered to discuss the problems and serious

consequences of the pandemic, as well as to establish commitments

and make deals capable of ensuring an intensified response to the glo-

bal HIV/AIDS epidemic.

séries EDUCATION FOR HEALTH volume 1

Regarding the great percentage of young people affected by AIDS

throughout the world, the UNGASS participants committed to facing

the challenges posed by the HIV/AIDS pandemic by adopting the

following measures

, among others:

1. Prevention must be the mainstay of our response.

52. By 2005 ensure: that a wide range of prevention programs which take

account of local circumstances, ethics and cultural values, is available in all

countries, particularly the most affected countries, including information,

education and communication, in languages most understood by communicates

and respectful of cultures, aimed at reducing risk-taking behavior and

encouraging responsible sexual behavior.

This commitment reinforces the Dakar Framework for Action

which proposes to achieve the goals and objectives of "Education

for All" and reaffirms that education is a fundamental right and

constitutes the key to the sustainable development of nations.

Because AIDS represents a menace to development, preventive

education must be a priority. "Programs to control and reduce the

proliferation of the virus must make the maximum use of the

potential of education to transmit prevention messages and change

attitudes and behaviors (UNESCO, Education for All, Dakar

Framework for Action, 17)

2. Realize that human rights and fundamental freedoms for

all are essential in reducing vulnerability to HIV/AIDS.

58. By 2003 enact, strengthen or enforce, as appropriate, legislation, regulations

and other measures to eliminate all forms of discrimination against and to

ensure the full enjoyment of all human rights and fundamental freedoms by

people living with HIV/AIDS and members of vulnerable groups, in parti-

15 Declaration of Commitment on HIV/Aids. World Crisis - World Response. Document

elaborated in the United Nations General Assembly Special Session on HIV/Aids between

25-27 June, 2001, in New York.

16 World Education Forum, held in Dakar, Senegal, from April 26-28, 2000.

UNESCO BRAZIL Notebooks

cular to ensure their access to, inter alia, education, inheritance, employment,

health care, social and health services, prevention, support and treatment,

information and legal protection, while respecting their privacy and confidentiality;

and develop strategies to combat stigma and social exclusion connected with the

epidemic.

Those people that are vulnerable must be given priority in

the response to the epidemic. Empowering women is

essential in reducing vulnerability.

62. By 2003, in order to complement prevention programs that address

activities which place individuals at risk of HIV infection, such as risky

and unsafe sexual behavior and injected drug use, have in place in all countries

strategies, policies and programs that identify and begin to address those

factors that make individuals particularly vulnerable to HIV infection,

including underdevelopment, economic insecurity, poverty, lack of

empowerment of women, lack of education, social exclusion, illiteracy,

discrimination, lack of information and/or commodities for self-protection,

and all types of sexual exploitation of women, girls and boys, including for

commercial reasons. Such strategies, policies and programs should address

the gender dimension of the epidemic, specify the action that will be taken to

address vulnerability, and set targets for achievement.

63. By 2003 develop and/or strengthen strategies, policies and programs

which recognize the importance of the family in reducing vulnerability,

inter alia, in educating and guiding children and take account the cultu-

ral, religious and ethical factors, to reduce the vulnerability of children

and young people by ensuring access of both girls and boys to primary

and secondary education, including HIV/AIDS in curricula for

adolescents; ensuring safe and secure environments, especially for young

girls; expanding good-quality, youth-friendly information and sexual

health education and counseling services; strengthening reproductive and

sexual health programs; and involving families and young people in

planning, implementing and evaluating HIV/AIDS prevention and

care programs, to the extent possible.

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3. To address HIV/AIDS is to invest in sustainable

development.

68. By 2003, evaluate the economic and social impact of the HIV/AIDS

epidemic and develop multisectorial strategies to address the impact at the indi-

vidual, family, community and national levels; develop and accelerate the

implementation of national poverty eradication strategies to address the impact

of HIV/AIDS on household income, livelihoods and access to basic social

services, with special focus on individuals, families and communities severely

affected by the epidemic; review the social and economic impact of HIV/

AIDS at all levels of society, especially among women and the elderly,

particularly the role as caregivers, and in families affected by HIV/AIDS,

and address their special needs; and adjust and adapt economic and social

development policies, including social protection policies, to address the impact

of HIV/AIDS on economic growth, provision of essential economic services,

labor productivity, government revenues, and deficit-creating pressures on public

resources.

The abovementioned goals reinforce the importance of the Youth

WG in the new AIDS scenario. In Brazil, implementing policies and

programs that use strategies centered on youth participation represent a

joint commitment between the government, the organized civil society

and international cooperation agencies.

The experience of giving young people responsibility and inviting

them to reflect upon the national response to the epidemic demonstrated,

through the context of the Youth WG, that young people who participate

in social movements are sensitive to the need for developing life skills,

that they need help in learning to recognize their own worth, and that as

a result they can acquire a different perspective of their own existence.

This study with young people is founded on the UNESCO mandate

inasmuch as its conception and implementation are based upon the four

pillar principles of knowledge.

17 "In order to find an answer to the hope we all have for a new education for the

new millenium, the committee presided over by J. Delors concluded that

education must be centered around four pillar principles of knowledge." (Abrin-

do Espaços, UNESCO Editions, 2001, pp 9) The aforementioned principles

can be found in the Delors Report.

UNESCO BRAZIL Notebooks

Learning to Know: According to Delors, "learning to know" is

learning that is associated with the mastery of learning tools. With this

definition, the Youth WG has deemed it essential to broaden the

knowledge of the group and its ability to continue motivating so that

the members can continue learning throughout their lives.

Learning to Do: This principle is intimately linked to the "learning

to know" principle and is related to the use of methodology and

technology so as to broaden the results of the study. The use of

technological tools, together with the group's familiarity and intellectual

production, significantly helped broaden the horizons of these young

people regarding the preventive efforts they had developed, as well as

with regard to their expectations in the professional world.

Learning to Live Together: Teaching people how to live together

is perceived as one of the biggest challenges in education. The members

of the Youth WG collectively and individually worked to get to know

their equals and respective realities, recognizing each other and finding

meaning in social and cultural diversity. In this way, it was possible to

reach a consensus in order to achieve the propositions contained in this

publication.

Learning to Be: The youths started to be appreciated with the work

they had been developing prior to participating in the group. Thus they

were reinforced in their efforts and were encouraged to develop their

thoughts so as to serve as actors with responsibility for their actions.

Learning to be is related to developing the participation that exists within

each of us.

The most apparent desire of the young people in this Working

Group is to participate fully and in an egalitarian manner in the

resolutions concerning the world we all share. They see themselves as

capable of contributing by assuming responsibilities, thanks to the roles

they play in their families, at college, at work, in their leisure environments

and in various educational contexts.

Prevention through education will always be the key to reducing

the rate of new HIV infections. It was a consensus during the conception

of this publication that each and every preventive intervention must be

adapted to the conditions of the various populations, and that each

must take into account gender issues, differences between urban and

rural areas and between young people in the school environment and

séries EDUCATION FOR HEALTH volume 1

out of it, since these issues are inherent in all dimensions of HIV

preventive education. More than ever, the creators of policies should

make every possible effort to consider the needs of young people and,

just as important, their ideas, as those may be answers capable of

contributing to sustainable development.

Given the above, our chances of success are considerable, as Brazil

has a nationally and internationally acclaimed program and a dynamic

organized civil society that has repeatedly distinguished itself in the

construction of a Brazilian response to the HIV/AIDS epidemic.

It is important to point out that this publication is above all an

instrument of political mobilization to be used by young leaders,

education and health professionals, opinion makers, civil society

organizations and public power as part of an effort to consolidate

educational and political practices concerning the AIDS epidemic.

It is from this perspective that UNESCO and UNAIDS continue

to strengthen their position as motivators of social change, facilitating

access to information, promoting awareness in favor of development

and contributing to behavior changes among the youth populations of

the world.

UNESCO BRAZIL Notebooks

YOUTHS BIOGRAPHIES

Ana Beatriz dos Santos – 24 years old

Bia, as she is known by her friends in the WG, is from Rio de Janei-

ro. She entered the social movement in 1992 when she was just 15.

Everything started with a speech about AIDS in the school she attended.

Upon listening to the speech she felt motivated to engage in some sort of

voluntary work, and the path she chose still surprises her today.

Little by little, Bia learned more about the civil society organization

known as Grupo pela Vidda/RJ, and she became enchanted by their

proposal of fighting for the rights of people who live with HIV. It was

in this group that she began her training as an educator to work with

prevention in youth groups. In 1994, she represented Grupo pela Vidda

in the organizing committee of the National Encounter of People Living

with HIV/AIDS. In subsequent years she worked as a technical assistant

in the Preventive Theater project centering on the discussion of STD/

AIDS prevention among youths and adolescents.

Ana Paula da Silva – 20 years old

Ana Paula was born in Niterói, Rio de Janeiro. She entered the

social movement through a TV and video course broadcasted by the

community TV BemTV and financed by the Solidary Community

Program. She was 17 at the time and was trained for six months in order

to implement communications dealing with specific subjects of relevance

to the school community.

Ana Paula's life has changed a lot since then. She is still involved

with NGO BemTV, representing the institution in various events and

contributing in the fulfillment of projects.

She is currently studying for the university entrance exam (vesti-

bular), and is hoping to study social communications. Since she is not

sure she will be able to attend a public university, she still intends to pass

an exam in order to work for the government and thereby fund her

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studies. She would also like to study English and do a specialization in

project management.

Daniel de Castro Leite – 21 years old

Daniel was born in São Paulo in October of 1981. He started his

fight for the rights of HIV carriers in 1998 by watching a speech of the

NGO APTA/SP at his school.

Daniel was in attendance at the Military Police School when,

together with some classmates, he formed a discussion group about

polemic subjects for teenagers such as HIV, STD, AIDS and drug abu-

se. Subsequently he entered the APTEEN program and was trained to

give speeches on HIV/AIDS for adolescents in schools and other

educational venues in his city.

During the year 2000 Daniel organized the First Forum of Young

Protagonists of SP together with Élida Miranda. Concurrently he was

invited to compose the UNAIDS Youth WG.

Daniel is currently studying Social Science at PUC in São Paulo,

and is finishing his research in the area of health anthropology. The

subjects of his study are children born with HIV who are now entering

adolescence.

Daniel plans to continue his research and work in order to give

continuity to the ideals of this Youth Working Group.

Élida Miranda dos Santos – 19 years old

Élida was born in the metropolitan area of São Paulo, in the

Damasceno neighborhood.

She began her "social road," as she defines it, in the National Street

Children's Movement, which nurtured her critical eye and taught her to

participate actively in any decisions regarding the social area.

In order to contribute with the public policies in favor of the rights

of children and adolescents, Élida has since 1997 participated in the

organization of meetings concerning this population with the various

governmental spheres. She took a TV and video course in the Associa-

ção Novolhar, where programs are developed by the students and aired

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on the university channel TV PUC. In addition she develops workshops

about sexuality, the reduction of the penal age and other subjects related

to the Child and Adolescent Statute.

Élida intends to study medicine in Cuba and in the future become

the President of Brazil.

Marco Antônio Franco Amaral – 22 years old

Marco Antônio was born in Uberlândia, Minas Gerais. He started

his work as a peer educator at MAB, the Brazilian Adolescents Movement,

in which he continues to participate. He has always acted in the area of

AIDS prevention and in other subjects surrounding the discussion, such

as sexuality, citizenship, behavior and others.

Marco Antônio studies psychology at the Federal University of

Uberlândia (UFU), but his passion for the youth movement has also led

him to teach General History in the Telecurso 2000 and in the "Alterna-

tivo" university entrance course.

In the future Marco Antônio intends to be a university professor

so as to effectively contribute to change in the realm of social relations.

He wants to be sure to participate in the construction of a fairer world

in which people at least have the right to make choices.

Mêires Moreira da Silva – 20 years old

Born in Santana do Cariri – Ceará in December of 1982, Mêires is

the fourteenth daughter in a family of 17 siblings, all of whom were

brought up by the mother alone.

When Mêires was 10 she started participating in the activities of

the Fundação Casa Grande and discovered that she could do a lot for

other people, as well as herself, through communication.

She participated in various activities and departments of the

institution, such as the museum, the library and even a program of

children's songs. After her work at the Fundação, Mêires presented the

Sunday program MPB Especial in which she composed special

presentations of singers of Brazilian music, describing their life and

work. At that time she made a special program about the singer Cazuza

and first talked about AIDS.

séries EDUCATION FOR HEALTH volume 1

Mêires then began researching subjects of interest to the

community, especially to young people. With this new perspective the

program changed its name and became "Papo Cabeça" (something like

Smart Talk), a program that continues to air every Sunday. The goal of

the program is to encourage people to reflect on the matter of behavior.

Mêires presents information, opinions and interviews with health

professionals, youths and adults about all kinds of subjects such as

violence, sexuality and human rights, among others. Currently she is

also the administrator of the Fundação Casa Grande publishing house,

which produces cartoons about regional legends and other subjects such

as condoms, AIDS and smoking.

Mêires has just finished high school and intends to study psychology

at the university level. Where she lives, however, there is no institution

that offers the course, so for the meantime she will study history until

she has the opportunity to tackle her chosen subject.

Sérgio de Cássio – 23 years old

Sérgio was born in Brasilia and lives in Ceilândia, which is an

administrative region of the Federal District that has been called an

"explosive" neighborhood due to the countless social, economical and

structural problems it faces.

Sérgio embarked on his course in the social movement in youth

groups of the Catholic Church, going through student movements and

in turn left-wing political parties. It was in 1997, when he won the Plastic

Arts prize of the Athos Bulcão Foundation, that he began his

involvement with institutions that promote citizenship. Together with

some friends he formed the Grupo Atitude, which dedicated itself to

visiting institutions, establishing partnerships and developing activities

that dealt with subjects such as prejudice and the absence of public

health policies, but which always related to AIDS.

Sérgio currently studies education at a private university in Brasilia.

In the future he hopes to finish his studies and continue working as a

peer educator, contributing so that young HIV/AIDS carriers and those

who face social exclusion can have access to new opportunities.

UNESCO BRAZIL Notebooks

GLOSSARY

ABUSE

The use of drugs, whether frequent or not, that compromises

affective, social and professional ties and has physical and psychological

implications.

ADDICTION

The impulse that makes individuals use a drug or a product in a

continuous and periodic manner in order to obtain pleasure or ease

tension, anxiety, fear or unpleasant physical sensations.

ARV – ANTI-RETROVIRAL

A class of associated medications comprising of anti-retroviral

therapy for HIV carriers or people who are sick with AIDS. It reduces

mortalities, especially with regard to opportunistic diseases.

CIVIL SOCIETY ORGANIZATIONS – SCOs

Expression adopted by the Inter-American Development Bank

(IDB) at the start of the 1980s to designate entities with certain legal

characteristics and special legislation that are foremost dedicate to

constructing or defending rights or economic progress and social

development.

DRUGS

Substances that when taken alter the consciousness, perception

and sensations, producing temporary or permanent changes in the

physical and emotional state of the individual.

EPIDEMIC

A disease that attacks many individuals simultaneously in the same

country or region but has no local cause. A periodic bout of infectious

disease.

séries EDUCATION FOR HEALTH volume 1

GENDER

Gender is the social distinction between male and female. Gender is

the sum of social and cultural values, attitudes, roles, practices and

characteristics based on the male and female sex. Gender relations reflect

and perpetuate specific dynamics of power between men and women, as

can be seen historically across cultures and in contemporary societies.

GENDER IDENTITY

An internal structure built upon the experiences of a person's life

stories that allows the person to organize a self-awareness and act socially

regarding his/her perceived sex and gender.

HARM REDUCTION

A set of public health measures designed to minimize the adverse

consequences of drug abuse, beginning with the premise that a drug addict

faces difficulties when such use is interrupted. Harm-reduction strategies

include the following: respecting the condition of the user without

encouraging the use of drugs; promoting the non-injected use of drugs;

guaranteeing that syringes and other drug-injection devices are not shared.

HOMOSEXUALITY

Sexual orientation and attraction between individuals of the

same sex.

HUMAN RIGHTS

Set of concepts and principles universally recognized as protecting

human dignity while at the same time promoting justice, equity, liberty

and life.

ILLICIT DRUGS

Drugs sold illegally, such as marijuana, cocaine, crack, speed and others.

LICIT DRUGS

Drugs that are sold legally, such as alcohol, cigarettes and

medications.

UNESCO BRAZIL Notebooks

MEN THAT HAVE SEX WITH MEN – MSM

This term was recently adopted by organizations that work with

AIDS in order to designate the sector of the male population that is

vulnerable to HIV infection and has sex with other men, considering

that some situations--such as prison life--favor such sexual practices

independently from the sexual orientation or identity of the individual.

NATIONAL COUNCIL FOR THE RIGHTS OF

CHILDREN AND ADOLESCENTS – CONANDA

An organization linked to the Ministry of Justice that has the task

of deliberating and supervising policies in favor of children and

adolescents, proposing the urgent and imperative integration of public

policies to the government and Brazilian civil society. The Council defi-

nes paradigmatic, guidance and referential directives that need to be

incorporated to the planning and implementation of the set of efforts

in order to ensure proper care for children and adolescents.

NON-GOVERNMENTAL ORGANIZATIONS – NGOs

Entities that fight for democracy and development and, at least

initially, promote social movements.

PANDEMIC

A disease that attacks great numbers of people simultaneously

throughout a region or in a large number of countries.

PARTNER INSTITUTIONS

Public, private or third-sector institutions that unite to execute a

partnership, i.e. a specific, pre-established activity.

PARTNERSHIP

A formal or informal agreement established between the parties

interested in executing a specific activity, with the core of that specific

activity being defined between those parties. Partnerships can be

technical, administrative, executive, logistic, financial and supportive,

among others.

séries EDUCATION FOR HEALTH volume 1

PREVENTIVE EDUCATION

Education that seeks to offer a safe means of preserving health

and, consequently, life.

PREVENTION SUPPLIES

Material resources used in HIV/AIDS prevention such as male and

female condoms and disposable syringes (used in harm-reduction strategies).

PUBLIC POLICIES

Set of actions and strategies established by one or more

governmental spheres (federal, state or municipal) with the goal of

efficiently achieving specific results as in, for example, public policies to

combat HIV/AIDS.

SAFE SEX

Sexual practices and behaviors that reduce the risk of contracting

and transmitting sexually transmitted diseases, especially HIV.

SCHOOL GUIDANCE COUNSELING

A department within a school that guides students regarding their

performance and cares for them regarding their behaviors, difficulties

and potentials.

SEX

The word "sex," in daily colloquial language, is often used in

reference to gender (male or female) or to the physical activity that

involves the genitals (to have sex).

SEXUAL ACTIVITY

A synonym for sexual behavior, it is the expression of sexuality in

which an erotic component is evident.

SEXUAL HEALTH

The World Health Organization states, "Health is the state of com-

plete physical, mental and social well-being, not simply the absence of

UNESCO BRAZIL Notebooks

disease." As to sexual health, it is the process of physical, psychological

and social-cultural well-being as it relates to sexuality.

SEXUAL IDENTITY

Sexual identity is the personal and total identity related to sex that

includes the way in which an individual identifies as a man, woman,

male, female or some combination added to his/her sexual orientation.

It is an internal structure, created over time, that permits the individual

to organize his/her self-awareness based upon sex, gender and sexual

orientation and to act socially considering his perceived sexual capacity.

SEXUAL ORIENTATION

Sexual orientation is the individual's internal perception regarding

his/her erotic and/or emotional involvement with the sex and gender

of his/her partner.

SEXUAL PRACTICE

Sexual practice is a pattern of sexual activity engaged in by an indivi-

dual or community with enough frequency to be considered a behavior.

SEXUALLY RESPONSIBLE BEHAVIOR

Sexual behavior that presents no risk to the self or others. It is the

type of behavior in which the expression of sexuality is characterized by

respect, honesty, self-protection, mutuality, consent, the search for pleasure

and well-being. Those who engage in sexually responsible behavior have

no intention of hurting others and therefore abstain from exploration,

harassment, manipulation and discrimination. A community promotes

responsible sexual behavior by spreading knowledge and by facilitating

access to condoms and other prevention resources.

SEXUAL RIGHTS

Because the protection of health is a basic human right, it follows

that sexual health involves sexual rights. The recognition of sexual rights

is undergoing a process of evolution. The health-promotion premise in

the context of human rights has been explicitly reinforced for the sake

of promoting reproductive health.

séries EDUCATION FOR HEALTH volume 1

SEXUALITY

The set of biological, psychological, social-cultural, ethical and

religious/spiritual aspects that refer to how people experience sex.

Sexuality is one of the dimensions of the human being and involves

gender, sexual identity, sexual orientation, eroticism, emotional

involvement, love and reproduction. It is explored or expressed in

thoughts, fantasies, desires, beliefs, attitudes, values, activities, practices,

roles and relationships. Along with the consensus that the social-cultu-

ral components of sexuality are critical for the conceptualization of

human sexuality, in theoretical approaches there is a clear tendency toward

the belief that sexuality refers not only to the human reproductive

capacity but also to pleasure.

SOCIAL CONTROL

The participation of the organized civil society in the elaboration,

implementation and enforcement of health policies. Its goal is to

stimulate the quality of public healthcare services and governmental

actions in response to the epidemic.

SOCIAL MARKETING

Social marketing is the strategic administration of the process of

introducing social innovations based on the adoption of new indivi-

dual and collective attitudes, behaviors and practices as guided by ethical

principles fundamented on human rights and social equity. Throughout

the world social marketing is becoming one of the most frequently

applied tools in the administration of social projects and programs.

STATE COUNCIL FOR THE RIGHTS OF CHILDREN

AND ADOLESCENTS – CONDECA

An autonomous, deliberative organization that formulates and

controls actions and/or policies relative to children and adolescents in

all Brazilian states and the Federal District.

THIRD SECTOR

A term that refers to a set of organizations that differ from the

state and the market because they generate a type of capital that is

UNESCO BRAZIL Notebooks

essentially social. Although the third sector remits directly to the logic

of the market in terms of employment and capital, what distinguishes it

from the other two sectors (government and market) is the possibility

of renewal for public life.

TUTELAGE COUNCIL

A permanent, autonomous non-jurisdictional municipal

organization charged by society with the task of ensuring respect for

the rights of children and adolescents.

VERTICAL TRANSMISSION

A term referring to mother/child HIV transmission. Vertical

transmission can occur during pregnancy, during labor and delivery, and

during the period after birth. It has been divided in three periods: intra-

uterine, during delivery and after delivery, and through breast-feeding.

The possibility of contamination of the child through breast-feeding is

approximately 14 percent. If acute maternal infection occurs during

breast-feeding, this possibility increases to 29 percent.

VULNERABILITY

To be vulnerable in the context of HIV and other STD infections

means to have little or no control of the risk of becoming infected,

while for those already infected or affected it means having little or no

access to adequate care or treatment. Vulnerability can be influenced by

personal, social or programmatic factors.

UNESCO BRAZIL Notebooks

BIBLIOGRAPHY

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