Challenges for safer sex education and HIV prevention in services for people with intellectual disabilities in Britain

Summary

This paper reviews progress and competence in HIV prevention work for people with intellectual disabilities in Britain. It identifies key challenges for specialist residential support and sex education services for people with intellectual disabilities, as well as for mainstream health promotion services. The discussion is informed by research and practice evidence and explores ways to develop competence in safer sex education, offering suggestions for HIV risk assessment and risk management. While the paper demonstrates that the politics of sexuality and HIV are difficult for services to manage, the rights of people with intellectual disabilities to information and support for sexuality and sexual health should be put first.

Opini

Pendidikan seks bagi orang-orang dengan disabilitas intelektual sangat kurang memadai. Padahal orang-orang dengan disabilitas intelektual mempunyai hak untuk seksualitas dan berekspresi secara seksual. Kondisi di lapangan adalah tingginya insidensi pelecehan seksual terhadap orang dengan disabilitas intelektual dan tingginya risiko infeksi HIV pada orang dengan disabilitas intelektual.

Titik fokus untuk pendidikan seks pada orang dengan disabilitas intelektual adalah hubungan mutualisme, negosiasi, dan persetujuan. Suatu kegiatan seksual dikatakan pelecehan apabila  pihak-pihak yang bersangkutan 1) tidak setuju, 2) tidak mampu menyetujui karena tidak paham akan situasi maupun hambatan dalam mengekspresikan pendapat, dan 3) mendapat tekanan untuk setuju dari pihak yang lebih berkuasa, misal keluarga atau tenaga kesehatan.

Dari jurnal ini saya mendapat informasi bahwa di negara Inggris, pendidikan seks menggunakan media video, diperankan oleh aktor-aktor dengan disabilitas intelektual pula, dan  boneka-boneka / puppet besar. Walaupun konten mengenai homoseksualitas sangat jarang dibahas dalam media video-video, sehingga berisiko tinggi penularan HIV. Selain itu bahasa yang digunakan harus diperhatikan agar mudah dicerna oleh sasaran dengan disabilitas intelektual. Contoh konkretnya adalah jangan menggunakan bahasa yang bersifat medis.

Situasi di Indonesia sendiri, orang-orang dengan disabilitas intelektual belum mendapatkan hak seksualitas mereka. Kondisi yang umum dijumpai adalah mereka sama sekali tidak mendapatkan pendidikan seks, dan rentan menjadi korban pelecehan seksual. Oleh karena itu, perlu dipertimbangkan pemberian pendidikan seks kepada mereka yang mengalami disabilitas intelektual dengan media yang memadai dan bahasa yang sederhana agar mudah dipahami.

Referensi

Cambridge, P. Challenges for safer sex education and HIV prevention in services for people with intellectual disabilities in Britain. Health Promotion International (1998) 13 (1): 67-74. Available at http://heapro.oxfordjournals.org/content/13/1/67.short [Accessed on August 30th 2016]

Community-based approach for prevention and control of dengue hemorrhagic fever in Kanchanaburi Province, Thailand

full article

Manirat Therawiwat1, Wijitr Fungladda2, Jaranit Kaewkungwal2, Nirat Imamee1 and Allan Steckler3 

 

Abstract

An action research design was conducted in two villages of Mueang District, Kanchanaburi Province to assess the effectiveness of a community-based approach program. Knowledge, perceived susceptibility, self-efficacy, and regular larval survey behavior were measured for program outputs. Container Index (CI), House Index (HI), and Breteau Index (BI) were used to confirm program outcomes. Key community stakeholders in the experimental village were identified and empowered through active learning in the village. Monthly meetings with the key stakeholders were used to share experiences learned, to reflect on the program outputs and outcomes as well as to plan for the next cycle of program activities. The program was quite successful. Knowledge, perception, self-efficacy, and larval survey practices in the experimental group were significantly higher than before the experiment, and higher than the comparison group. CI, HI, and BI were decreased sharply to better than the national target. Community status as community leaders was the best predictor for larval survey behavior at the first survey. Participating in the study program activities was the best predictor at the end of the program. The results from this study suggest that the dengue hemorrhagic fever (DHF) prevention and control program at the sub-district health level should be more proactive and emphasized at the village level. Monitoring the disease control program outputs and outcomes should be performed regularly during monthly meetings. Finally, local health officers need to be empowered for these matters  

OPINION

Efforts to control Aedes mosquitoes have been redirected from local health services at the provincial level to community-based control using village health volunteers. Efforts have not been effective and DHF is still a major health problem in all areas of the country. The one cost-effective measure that provides effective disease control over the long run is involving the persons who are responsible for creating or tolerating Aedes aegypti larval habitats in the local community environment in control or elimination of those habitats. They will learn that it is in their best interest to participate with other members of their community to create community ownership of their program (Gubler and Clark, 1996).  

the community-based empowerment program that allowed the key community stakeholders to actively participate in continuing education activities starting from conducting a community survey, identifying the problem, planning, action and observation, reflection, and re-planning with the sub-district health officers and researcher. Representatives of each household developed the control or elimination of mosquito breeding places and weekly larval survey activities with the assistance of the key stakeholders of that village zone. The activities at the household level were more specific to each household context, specifically the mosquito breeding places. The activities were also developed around the basic concept of the problem solving process. In this case, the activities were started from mapping of possible breeding places of mosquitoes in and around the house, identification of the breeding places, identification of possible solutions, implementation the selected solutions, monitoring and evaluation of the implementation outcomes through regular larval surveys. Besides these activities, the learning experiences of each key community stakeholder were shared and discussed in a monthly meeting in the village. The experiences were used as the inputs for project activities monitoring and re-planning.

Empowering key community stakeholders through active participation in on going activities played a great role in program success. Working for DHF prevention and control in the village as a partnership among primary, secondary, and tertiary stakeholders was also crucial.

 

Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin

Abstract:

Background - Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors — elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle — are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.

Methods - We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.

Results - The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.

Conclusions - Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

My Opinion:

From the article, the hypothesis formed was proven that lifestyle intervention and metformin succeeded in preventing or delaying diabetes in persons with high risk of the disease. This approach is not popular because type 2 diabetes or non-insulin-dependent diabetes mellitus is usually treated for after complications arise. Preventing metabolic diseases through diet and lifestyle has long been advised by health care professionals but prevention with the usage of a drug is not common. This research proved to be effective because it was systematic and intensive. Both lifestyle interventions and metformin groups showed effective results individually.

With the help of dietitians, nutritionists and fitness trainers, I believe a better prevention may be possible for persons with high risk of diabetes. Surveys and screenings can be conducted by family physicians, general physicians, nurses and midwives in the community they are entrusted to serve to identify those with high risk. From the article, persons of age 25 and above with BMI of more than 24 (22 for Asians) were selected.

This approach is very much possible in an Asian setting, more specifically in Yogyakarta city. This is because with the help of the midwives and the primary health centers (Puskesmas), mass screenings can be done thoroughly and prevention be carried out immediately. The people with high risk of diabetes need to be able to prevent diabetes that could lead to many other complications in the future.

The few problems that may arise are:

• Lack of compliance of participants 
• Under-reporting of cases due to distance from the Puskesmas 
• Availability of metformin drugs 
• Accessibility of dietitians, nutritionists and fitness trainers to target groups 

If proper and intensive counselling - as how was conducted in the research - is carried out, the prevention of type 2 diabetes can materialize and in turn reduce the medical costs and increase quality of life. Further researches can be carried out to single out the effect of lifestyle intervention and metformin in preventing diabetes among males and females, different age groups and different economic status groups.

Reference:
http://www.nejm.org/doi/full/10.1056/NEJMoa012512#t=article

Sex Trafficking in Nepal: A Review of Intervention and Prevention Programs

Abstract:
Trafficking of girls and women for the purpose of sexual exploitation is a problem worldwide, particularly in South Asia. This review focuses on Nepal-to-India sex trafficking with an examination of current anti-trafficking intervention and prevention programs. The activities of both governmental agencies and nongovernment organizations are described and critically analyzed. Suggestions for evaluating and improving interventions, and thereby reducing the trafficking of girls and women, are discussed.

My opinion:
Antitrafficking programs in the Nepalese context can be divided into prevention programs, indirect prevention, remediation, and advocacy. Prevention programs include direct education about trafficking and/or safe migration practices, “awareness raising” programs, and patrolling the country’s borders. Indirect prevention includes women’s rights programs, microcredit lending, and education programs for women or formal schooling for girls. Remediation includes efforts toward the care and support of trafficking survivors, programs for their rehabilitation, and attempts to reintegrate them into their communities. Advocacy includes prosecution of traffickers and the enforcement of laws against trafficking.

Anti-trafficking program conducted in Nepal can be a reference for me in making my program, the activities carried out by NGOs in Nepal are fairly easy to implement. Prevention activities in Nepal include awareness raising and social mobilization, such as increased community surveillance, as well as improved opportunities for livelihood and the interception of suspected trafficking victims at border checkpoints. These are executed through rallies, seminars, street theater performances, prevention camps, community support groups, and peer education. Maiti Nepal sets up “prevention homes” for women who are thought to be at high risk for trafficking. Women live in the home for a period of 4 to 6 months, during which time they receive counseling, skills training, health care education, and information on trafficking and sexually transmitted infections, including HIV.

Reference:
http://vaw.sagepub.com/content/17/5/651.full.pdf

NGO Responses to Trafficking in Women

Abstract:
As trafficking worldwide has become increasingly more sophisticated and widespread, some governments are implementing new legislation, hosting international conferences, and signing new and existing conventions. The United Nations (UN) and other Inter-Governmental Organisations (IGOs) are dedicating substantial resources to developing more effective solutions. However, the relative absence of government initiatives and assistance for trafficking victims, means that it is NGOs who have taken up the challenge of organising locally, nationally, and internationally to advocate for and meet the needs of victims, despite their limited resources. This article provides an overview of NGO activity against trafficking in women for sexual exploitation. It is based on an exploratory study undertaken by the Change Anti-Trafficking Programme (ATP) in 2001. The article explores why NGOs are well-placed to work with women victims of trafficking, and their responses to the growing phenomenon in countries of origin and destination. It presents a regional overview of NGO initiatives, and concludes by discussing some of the main obstacles faced by NGOs in combating trafficking for sexual exploitation, and women's and children's vulnerability to slavery-like practices.

My opinion:
The journal talks about how the role of NGOs in responding to trafficking in women. Activities of various NGOs in various regions countries are summarized into one. Once collected there are facts about the activities characteristics the primary focus of each region. It is said in this journal, socio-cultural factors that vary are caused each NGO is unique. Prevention through regulations for developed countries such as Europe countries are effective. Whereas in developing countries cannot yet be applied, and more focused on aftercare services.

NGO activity in the prevention of human trafficking include: information campaigns, gender education in schools, vocational training for women, training of teachers and school counselors to identify those at risk, and facilitate risk women to access employment and career development opportunities. Preventive measures are intended to raise awareness of trafficking, risk recognition, to avoid vulnerable situation, and network support is a critical component of any anti-trafficking strategy. My program is also based on the prevention actions in this journal. Although mentioned, that need special attention in the "demand" side of trafficking


Reference:
http://www.tandfonline.com/doi/abs/10.1080/13552070215893