During the summer of 2007, I designed and conducted a formative investigation of HIV risks and prevention in drug treatment centers located in Guatemala City and San Salvador. The project was done through Universidad del Valle- Centro de Estudios en Salud (UVG-CES) and the Centers for Disease Control Global AIDS Program, Central America and Panama Region (CDC-GAP, CAP), whose headquarters are located in Guatemala City. Specifically, the project was carried out at the request of the Mexico City UN Office of Drugs and Crime's (UNODC) regional project, CAM H90, which seeks to establish and strengthen a network of drug treatment centers throughout Central American countries.

Very little is known about injection drug use (IDU) in Central America. Therefore one of the main objectives was to estimate IDU in selected drug treatment centers. Additionally, the study intended to describe the institutional structure of drug treatment and arrive at a better understanding about how HIV themes are managed in drug treatment centers in Guatemala City and San Salvador. A final aim was to determine how drug treatment could be improved by taking into consideration HIV/AIDS prevention.

Four drug treatment centers in Guatemala City and three centers in San Salvador participated in the project. The study consisted of two parts: 1) a three-question survey of all clients in the drug treatment centers that participated in the study, and 2) in-depth interviews with selected staff and clients. The survey was implemented for 4 weeks in each center asked all clients who received treatment during this time period whether they had even had an HIV test, whether they had ever injected drugs, and whether they had injected drugs in the last 30 days. Among the topic included in the interviews were: modalities of drug treatment in practice in the center, drug use and condom use behavior, knowledge about HIV transmission routes, perceived individual HIV risk, and perceptions about how the treatment centers currently manage HIV risk and prevention.

During my last week of field studies, my preceptor and I presented preliminary results from the surveys and the interviews to local stakeholders. The presentation was also emailed to all who participated and all interested parties. As part of the agreement with UNODC, I will write a final report with our findings and recommendations. UNODC intends to publish and disseminate the report to drug treatment centers and National AIDS Programs in Central American countries.

What worked: Planning for the project began in February 2007. I began the IRB application in the spring in order to have approval for data collection by the time I arrived in Central America. This allowed me to devote my time abroad to coordinating with local agencies and being in the field. Additionally, throughout the summer I had tremendous support and supervision from Dr. Martin Iguchi at UCLA and my preceptor, Dr. Jerry Jacobson, which ensured a rewarding experience.

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My summer of 2006 internship was conducted with the Women’s International Network for Guatemalan Solutions (ALAS/WINGS), a non-profit US/Guatemalan organization founded by former US foreign-service agent Sue Patterson in 2001. The mission of WINGS, which has its central office in Antigua, Guatemala, is to increase access to knowledge of reproductive health, financial resources, and contraceptive methods, mainly for rural impoverished communities. To fulfill this mission WINGS works closely with organizations such as APROFAM (the Pro-Family Association). The branches of the organization include family planning talks, referrals to contraceptive methods, a health promoter-training program, a cervical cancer-screening program, and a youth peer education group.

Guatemala is one of the poorest countries in the Western Hemisphere, with the majority of the population, especially the indigenous Mayan population, living in poverty. Guatemala also has the highest rate of population growth in all of Latin America, and, at the same time, it maintains poor health statistics especially concerning the health of women and children. These poor maternal and child health statistics are partially linked to the lack of education and access to family planning and reproductive health, especially in the rural areas of the country, where most of the population resides. Since it was founded, WINGS has been directly attempting to address these issues through outreach and education in some of the areas with the poorest health statistics. However, WINGS has yet to collaborate with one of the strongest influences on family planning in the country: religion. As in most Latin American countries, Guatemala is strongly rooted in religion, especially that of Roman Catholicism and Evangelicalism.

For the summer of 2006, Program Director Meira Neggaz created an internship position which allowed me to conduct extensive formative research on: the religious background in Guatemala and its response to family planning, religious programs that work in family planning, and the possibility of creating a religious family planning program through WINGS. The results of the investigation were somewhat surprising, and the I was able to accomplish much more than originally thought possible. I found that, although traditionally and publicly the two religions, especially Catholicism, are generally against incorporating modern family planning (i.e. the use of contraceptive methods) into churches, privately, church leaders are not only willing to collaborate but feel that family planning education is a necessary part of church-life. Through the background research, literature review, and key informant interviews with both priests and pastors in many of the areas where WINGS currently works, the I was able to design a program manual for the Religious Leaders Collaboration Program. The program leader will consult with various leaders, including the ones that I already contacted, to design family planning talks that are congruent with both the values of that particular church as well as the mission of WINGS. This program will be implemented in 2007.

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Women’s International Network for Guatemalan Solutions (WINGS) was founded in 2001 by Sue Patterson and operates out of Antigua, Guatemala . WINGS is an Non-governmental Organization registered in both the USA and Guatemala . Its mission is to increase access to contraception and reproductive health care by addressing common obstacles such as geographic isolation, lack of financial resources and education, and cultural barriers. To achieve this goal, WINGS works closely with Guatemalan Non-Governmental Organizations, such as APROFAM (Pro-Family Association) and government health centers, reaching out to rural communities, subsidizing the cost of family planning methods, providing cervical cancer screening for the poorest Guatemalans, and offering seminars on reproductive health to rural poor Guatemalans.

In Guatemala , cervical cancer is the first leading cause of cancer-related death among women of reproductive age and the second leading cause of cancer-related death among women of all ages. To address this problem, WINGS operates the Cervical Cancer Prevention Program series, which consists of a health education talk, Pap smear clinic, delivery of results and coordination of follow-up services. During the series, WINGS staff provide information on family planning methods and offer referrals for services. WINGS works with local organizations and individuals who help coordinate the series, which takes place on-site in the community. Loudres Tojín, the Cervical Cancer Prevention Program Coordinator, manages the programs’ operations and conducts health education talks. Carmen Ordóñdez is the Field Nurse that conducts Pap smear clinics.

Program Director, Meira Neggaz, created a Summer 2005 intern position to write a manual formalizing program protocol, educational materials, and develop an evaluation system. From July through September 2005, I worked closely with WINGS staff to design educational materials for the health education talks, including a flip chart and tri-fold brochures, and to establish a program implementation plan. Further, I had the opportunity to conduct on-site field observations of the Pap smear clinics. I collaborated with Meira to develop evaluation methods, including staff performance, tracking patients throughout the program, and pre-/post-tests for health education talks. From this point on, WINGS staff will use the Cervical Cancer Prevention Program Manual and all accompanying forms as a guide to daily operations and in future program and funding development.

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ORGANIZATION: Women’s International Network for Guatemalan Solutions (WINGS)/ Asociación ALAS de Guatemala
LOCATION: Antigua, Guatemala
STUDENT:: Grace Lee
YEAR: Summer 2005

I conducted my internship with Women’s International Network for Guatemalan Solutions (WINGS)/Asociación ALAS de Guatemala, a nonprofit organization based in Antigua, Guatemala that seeks to improve the reproductive health of people living in underserved communities of Guatemala. Founded in 2001, the mission of WINGS is to increase access to reproductive health care by addressing common obstacles such as geographic isolation, lack of financial resources and education, and cultural barriers. Originally founded to improve rural indigenous women’s reproductive health care, WINGS has expanded to provide education and outreach services, and its target populations have expanded to include males and adolescents. WINGS currently operates four major projects: the Family Planning Initiative (providing family planning education and methods), the Cervical Cancer Prevention and Treatment Program, the Sexually Transmitted Infection Testing and Treatment Initiative (STI Prevalence Study), and the Youth WINGS peer education project.

I worked specifically with the Youth WINGS peer education project (ALAS Jóvenes) which began as a pilot project in 2004. Sexual and reproductive health education is inadequate in the communities served by WINGS, where adolescent pregnancy is common and STIs and HIV are rapidly spreading. Forty-six percent of Guatemalans are under the age of fifteen, and 34% of boys and 22% of girls are sexually active by age 15, indicating the need to address sexual health concerns specific to youth. Twenty percent of females have two or more children by age eighteen, and 50% of women have a child by age nineteen. In addition, 24% of Guatemalan women report having an unmet desire for family planning. Only 50% of girls in rural areas receive any schooling, and a lack of education and illiteracy are strong predictors of early pregnancy. ALAS Jóvenes trains selected youth ages 14-24 in rural, predominantly Mayan communities, to provide information on reproductive health and family planning to other youth within their communities. Youth “multipliers,” or peer educators, are trained to provide education, referrals, and condoms to community members and to conduct presentations on sexual education.

The majority of my work involved curriculum development for the youth peer educators. I edited the Reference Manual for youth peer educators and created materials for each of the five modules of the Phase I curriculum, including lesson plans, workshop activities, and a baseline questionnaire. I compiled the results of the community needs assessment interviews in order to assist in the selection of six communities in which to implement the youth peer education program. I designed the Phase II curriculum (which will be used as additional intensive training for youth peer educators who have completed Phase I). I conducted two site visits to observe a presentation for the adult family project and to observe needs assessment interviews with community members. I designed a focus group guide for future use in conducting an evaluation of ALAS Jóvenes. I also revised many of the youth WINGS forms and paperwork to be more culturally appropriate. My experience with WINGS was extremely valuable, as I gained critical thinking and problem solving skills from confronting the daily challenges that arise in an applied setting. I would like to thank the Bixby Foundation for making my internship possible.

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In 2003, the Population Council fielded a qualitative study titled "Understanding the Lives of Indigenous Young People in Guatemala" regarding the available opportunities (education, vocational, health services) and desires of Mayan adolescents in Guatemala. Based on the study findings and information gathered from local NGOs, the Population Council designed an appropriate and feasible community-level intervention. The intervention involves local Mayan NGOs and Mayan girls from the surrounding communities where each NGO works. Each participating NGO recruits, interviews and selects 3-4 girls (15-20 years old) to participate in the project. These girls are then trained in 6 skill areas (leadership, professional skills, vocational skills, community work, reproductive health, and life skills) and are responsible for going back to their communities and working with girls age 10-14 in these same topic areas. In addition to the community level work, the 15-20 year female leaders will be participating in an internship program at the NGO who selected them.

All of my field studies activities were directly related to the above mentioned project, including the fielded qualitative study. I participated in the interviewing and selection of 15-20 year old indigenous women to participate in project. I edited the Qualitative Data Analysis Final Report, and wrote and prepared the summary document "Voices of Vulnerable and Underserved Adolescents in Guatemala - A Summary of the Qualitative Study: Understanding the Lives of Indigenous Young People in Guatemala." I also updated interview guides in Spanish for an upcoming Adolescent Program Inventory that will be conducted by the Population Council. Finally, I assisted with the organization and execution of a national-level forum on adolescent programs in Guatemala titled "Utilizing Multisectoral Strategies to Better the Lives of Vulnerable Young People in Guatemala."

I would like to thank the Bixby and Drabkin Foundations for providing me with the funding to make this internship possible. I had a wonderful time in Guatemala and while the actual internship activities were not exactly as I had envisioned, over the course of eleven weeks, I learned a lot about myself and my professional goals. My experiences (both personal and professional) in Guatemala have strengthened my commitment to work in the field of reproductive health and family planning. I fully intend to continue to focus my personal and professional efforts towards creating a world where all women and men have access to affordable and safe family planning methods and control over their fertility.

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ORGANIZATION: Population Council / Frontiers
LOCATION: Guatemala City, Guatemala
STUDENT: Leah Maddock
YEAR: Summer 2004

I spent 11 weeks in Guatemala assisting with the initial steps of "Increasing Access to Vasectomies in Guatemala." I worked for the Population Council in association with Frontiers. Both organizations work in developing countries to address specific reproductive and public health needs through providing services and conducting research.

Guatemala's high birth rates and poor education system have lead to a dearth of information about many highly effective contraceptives, including vasectomy. The main objectives of this project were to: inform Guatemalan couples about the availability and characteristics of vasectomy; and to make vasectomies more accessible in Guatemala through provider training.

This study targeted men, women and providers and staff at the four study sites and 22 referring clinics. Two of the four sites already offered vasectomy services on demand, however only five vasectomies were completed at the two sites total in 2003, and neither site actively promoted the method. After we provided training in how to promote vasectomies, the study will provide a surgeon to train providers to perform vasectomies.

During my internship I created:

Media material including a flyer (half page), sign (11" x 17"), and pamphlet to hand out to patients and hang in the four sites and 22 referring clinics. They were titled "Family Planning is something for men too." The pamphlet provided a brief description of vasectomies and tubal ligations, listed their benefits, offered hints on initiating a discussion with your partner about such subjects. The signs and flyers include bullet points of information about vasectomy; where to obtain additional information and free cost of the procedure. We validated the media material at the four sites and 65 providers or patients. This information was summarized, and I edited media material accordingly.

I created pre- and posttest for providers to complete immediately before and after the half day training sessions. The tests include demographic questions; if the provider had ever performed / assisted in a vasectomy; referred a patient to vasectomy services; and how often providers speak to their male and female patients about vasectomy. A series of true / false questions assessed knowledge about vasectomy. Additionally a mix-match set of 5 questions asks providers to match one of five methods of birth control with its proper definition.

This experience focused my attention on the differences and unique difficulties faced by developing countries, and within an international organization. During my time in Guatemala I improved my Spanish, developed ideas towards my career goals and found great satisfaction in working in such a warm and welcoming culture.

None of this would have been possible without the help of the Bixby Foundation. Through guidance and financial assistance I had an incredible experience that not only increased my understanding of international reproductive health, but also supplied real life experience to my career in reproductive health. Thank you.

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