IDRC CRDI CIID Gender, Health, and Sustainable Development: A Lawn American Perspective Proceedings of a Workshop held in Montevideo, Uruguay, 26-29 April 1994 Edited by Pandu Wijeyaratne, Janet Hatcher Roberts, Jennifer Kitts, and Lori Jones Arsenault Gender, Health, and Sustainable Development: A Latin American Perspective Proceedings of a Workshop held in Montevideo, Uruguay, 26-29 April 1994 Edited by Pandu Wijeyaratne, Janet Hatcher Roberts, Jennifer Kitts, and Lori Jones Arsenault INTERNATIONAL DEVELOPMENT RESEARCH CENTRE Ottawa Cairo Dakar -Johannesburg Montevideo Nairobi New Delhi Singapore Published by the International Development Research Centre PO Box 8500, Ottawa, ON, Canada K1 G 3H9 September 1994 Wijeyaratne, P. Hatcher Roberts, J. Kitts, J. Jones Arsenault, L. IDRC, Ottawa, ON CA Gender, health, and sustainable development : a Latin American perspective; proceedings of a workshop held in Montevideo, Uruguay, 26-29 April 1994. Ottawa, ON, IDRC, 1994. 276 p.: ill. /Women/, /gender/, /health conditions/, /Latin America/ -/men/, /aids/, /sexually transmitted diseases/, /occupational diseases/, /tropical diseases/, findigenous population/, /health personnel/, /conference reports/, /case studies/, bibliographies. UDC: 396:613(8) ISBN: 0-88936-748-5 A microfiche edition is available. Material contained in this report is produced as submitted and has not been subjected to peer review or editing by IDRC Public Information Program staff. Unless otherwise stated, copyright for material in this report is held by the authors. Mention of a proprietary name does not constitute endorsement of the product and is given only for information. Contents Foreword Janet Hatcher Roberts Acknowledgments Introduction: Opportunities and Challenges for Improving Women's Health Status Aleya El Bindari Hammad 1 Opening Address: Health Policy Research in Latin America and the Caribbean; the Role of the Household Tony Tillett 7 AIDS, Sexually Transmitted Diseases, and Gender AIDS Research from a Gender Perspective Leda Pesce 19 Male Bisexuality, Gender Relations, and AIDS in Brazil Carmen Dora Guimardes 26 Love Does Not Protect Against AIDS: Reflections about the HIV/AIDS Epidemic from a Gender Perspective Elsa do Prado 35 Counsellors' and HIV-Positive Patients' Perceptions of Gender Differences in HIV/AIDS Education and Counselling Rafael Garcia, E. Antonio de Moya, Rosario Fadul, Aida Freites, Sara Guerrero, and Cesar Castellanos 9 Sexual Initiation of School-Age Adolescents in Santiago, Chile: The Implications of Gender, Religion, and Family Structure Paulina Pino Z., Ramon Florenzano U., and Alfredo Nudman 51 Besides Carnival and Soccer: Reflections about AIDS in Brazil Arletty Pinel 62 Discussion 73 Environmental Stress, Production Activities, Health, and Gender Gender and Occupational Health in Chile Ximena Dial Berr 77 Health at Work: A Gender Perspective Jaime Breilh 85 Gender and Occupational Health in Venezuela Doris Acevedo 94 Discussion 103 Tropical Diseases and Gender Considerations for the Control and Prevention of Neurocysticercosis Elsa J. Sarti 107 Socioeconomic, Cultural, and Psychosocial Factors of Congenital Chagas' Disease Ocatvio Sotomayor, Jenny Davalos J., Freddy Pena C., Rolando Urgel, Melvy A., Vargas B., and Oscar Pinto 15 Gender Differentials in the Acquisition of Forest Leishmaniasis Clara Cdrdenas Timoteo and Alejandro Llanos-Cuentas 125 Socioeconomic Impact and Gender Differentials of Cholera Claudia Durana 134 Discussion 141 Indigenous Peoples' Health Issues New Models of Participation in Indigenous Peoples' Health Xochitl Herrera and Miguel Lobo-Guerrera 145 Women's Participation in the Organization of Community Well-Being Maria Teresa Castillo and Maria Dolores Viga 154 Differential Prevalence of Malaria in Costa Rica: Ethnic Origin and Gender Alvaro Dobles-Ulloa and Catherine Perriard 165 Health Among the Mapuches of Chile Teresa Durdn P., Jose Quidel L., and Catriquir C. Desiderio 172 Discussion 181 Health Care Providers Gender Differentials and Primary Health Care Constanza Collazos V. 185 Health Promoters: Invisible Providers of Care Ilta Lange, Alicia Aguilo, and Carmen Barros 194 Psychosocial Determinants of the Use of Maternal-Child Health Services in Areas of Poverty Maria Bonino 199 Knowledge, Attitudes, and Practices of Women Concerning Pregnancy and Birth Giovanna Chiarella 208 A Need for Research on Women's Health Jasna Stiepovich and Julia Ramirez 220 Discussion 227 Working Group Discussions Principle Goals for the Workshop 231 Working Group Discussions 233 Working Group I 235 Working Group II 237 Related Topics and Initiatives Informally Presented at the Workshop Gender Analysis and Health Research 243 Case Study: Adolescents and Sexually Transmitted Diseases 246 Gender and Development Unit Healthy Women Counselling Guide/Healthy Communication with Rural Women 247 Discussion 251 Ane Haaland Agenda 253 Participants 259 Foreword The collection of papers which appear in this manuscript emerged from a workshop on Gender, Health, and Sustainable Development, sponsored by the International Development Research Centre (IDRC). This collaborative effort by IDRC's Health Sciences Division, the Gender and Development Unit of the Corporate Affairs and Initiatives Division, the Latin American and Caribbean Regional Office, and the Special Program for Research and Training in Tropical Diseases (TDR) of the World Health Organization (WHO), was held in Montevideo, Uruguay, 26-29 April 1994. The workshop included invitees from Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Dominican Republic, Mexico, Nicaragua, Paraguay, Peru, Uruguay, Venezuela. It focused on five topic areas which were identified as priority themes in Latin America: (1) AIDS, Sexually Transmitted Diseases, and Gender; (2) Environmental Stress, Production Activities, Health, and Gender; (3) Tropical Diseases and Gender; (4) Indigenous Peoples' Health Issues; and (5) Health Care Providers. This workshop is the second of a series of regional workshops on Gender, Health, and Sustainable Development. The first workshop was held in Nairobi, Kenya, in September 1993. Two more complementary workshops are planned: one in the Caribbean region late in 1994, and one in the Asian region early in 1995. These workshops are the result of two initiatives. First, in 1989-1990, an initiative was jointly undertaken by IDRC's Health Sciences Division and the Gender and Development Unit and TDR/WHO. These agencies sponsored two essay competitions on gender and tropical diseases. Selected essays were then published in two reports entitled Women and Tropical Diseases and Gender and Tropical Diseases: Facing the Challenge. It was decided that the next step forward from these competitions would be to hold a workshop with a wider focus, integrating the exploration of gender and tropical disease issues with other priority gender and health issues. The second, more recent, initiative relates to the establishment of the Global Commission on Women's Health by the WHO, in response to a World Health Assembly resolution in 1992. The Global Commission seeks to raise the profile of women's health to a global level, and to develop policy responses at the country level to address inequities. Major gaps still exist in our understanding of gender and health. In many countries, there is a serious lack of careful and rigorous research which is needed to support relevant policy decisions. The decision by IDRC to host a series of regional workshops which would discuss research issues, gaps, and roadblocks to conducting gender and health research, was seen as a positive contribution to the work of the Global Commission. The workshop consisted of a number of interrelated components. To begin with, there were five thematic plenary sessions in which selected participants highlighted the main research findings of their projects, and then identified the gender issues involved. In-depth discussions, involving all participants, followed each presentation. A shorter session on the elements of gender analysis in health research was conducted to further sensitize participants to the issues. Smaller work groups were established to identify gaps in research, roadblocks to conducting research, and priority areas for future action. This collection of papers represents a significant advancement on gender, health, and sustainable development issues, from a Latin American perspective. Capacity to further develop expertise with regard to gender analysis was identified as a priority by the participants. The final outcome of the workshop was a draft research agenda for gender and health, and a commitment by the participants to begin a process of improving interdisciplinary research in this area. This publication, as well as the publications from the other regional workshops on Gender, Health, and Sustainable Development, represent an important part of IDRC's contribution to the deliberations of the Global Commission on Women's Health, as well as a strategic component for health for the Women and Development Conference to be held in Beijing in September 1995. Janet Hatcher Roberts Senior Program Specialist Health Policy Health Sciences Division Acknowledgments This workshop, and the publication of its proceedings, were made possible through a grant from the International Development Research Centre. We wish to express our thanks to the Montevideo-based members of the Organizing Committee, who contributed so much of their time, effort, and enthusiasm to the smooth management and running of the