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This paper presents data on the role and implementation of street theatre as a communications technique for HIV behavioral interventions in low income slum communities in Mumbai. Second, we situate the uses of street theatre as a social intervention strategy within a long history of outdoor drama as entertainment and social action in India. Street theatre with accompanying activities was a central element of the RISHTA project’s communications strategy in communities in Mumbai, designed to deliver tailored risk reduction messages to married men who were involved in extramarital relationships. The paper presents examples of the contents and delivery of alcohol risk reduction messages through street plays that were developed and performed by actors from low income communities. The paper situates street plays as part of the domain of prevention strategies, which can be effective in reducing HIV risks, including those related to alcohol use.

ضمن سلسلة الكتب الثقافية الشهرية التي يصدرها بيت الحكمة العراقي (عالم الحكمة) صدور الكتاب الموسوم : دراسة الانثروبولوجيا المفهوم والتاريخ عن قسم الدراسات الاجتماعية في بيت الحكمة تأليف بيرتي ج بيلتو وترجمة كاظم سعد الدين كتاب من الحجم المتوسط (168) صفحة ويحتوي على الفصول التالية : الفصل الأول : (دراسة الانسان) ويحتوي على (8) بحوث والفصل الثاني : (تاريخ الانثروبولوجيا) ويحتوي على (11) بحثا والفصل الثالث : (منهاج البحث الأنثروبولوجيا) ويحتوي على (3) بحوث اما الفصل السادس والاخير : فيتكون من المقدمة وتعميمات وإيضاحات منهجية.

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

In this article we argue that the concept of knowledge, as utilized by public health professionals, is best regarded as cultural belief, as defined in anthropology. The implications of this position are explored, particularly as it relates to the development of a decision-making approach to the understanding and analysis of health care behavior. The methodological challenges posed by the new theoretical perspective that has emerged from the emphasis on decision making is discussed from the perspective of applied research. The role of focused ethnographic studies is examined and contrasted with ethnomedicine and survey approaches. Some main features of focused ethnographic methods are described and illustrated with a case example of acute respiratory infection (ARI) in Gambia.

This paper traces the role of alcohol production and use in the daily lives of people in India, from ancient times to the present day. Alcohol use has been an issue of great ambivalence throughout the rich and long history of the Indian subcontinent. The behaviors and attitudes about alcohol use in India are very complex, contradictory and convoluted because of the many different influences in that history. The evolution of alcohol use patterns in India can be divided into four broad historical periods (time of written records), beginning with the Vedic era (ca. 1500–700 BCE). From 700 BCE to 1100 CE, (“Reinterpretation and Synthesis”) is the time of emergence of Buddhism and Jainism, with some new anti-alcohol doctrines, as well as post-Vedic developments in the Hindu traditions and scholarly writing. The writings of the renowned medical practitioners, Charaka and Susruta, added new lines of thought, including arguments for “moderate alcohol use.” The Period of Islamic Influence (1100–1800 CE), including the Mughal era from the 1520s to 1800, exhibited a complex interplay of widespread alcohol use, competing with the clear Quranic opposition to alcohol consumption. The fourth period (1800 to the present) includes the deep influence of British colonial rule and the recent half century of Indian independence, beginning in 1947. The contradictions and ambiguities—with widespread alcohol use in some sectors of society, including the high status caste of warriors/rulers (Kshatriyas), versus prohibitions and condemnation of alcohol use, especially for the Brahmin (scholar-priest) caste, have produced alcohol use patterns that include frequent high-risk, heavy and hazardous drinking. The recent increases in alcohol consumption in many sectors of the general Indian population, coupled with the strong evidence of the role of alcohol in the spread of HIV/STI infections and other health risks, point to the need for detailed understanding of the complex cross-currents emerging from the past history of alcohol use and abuse in India.

The medical abortion drugs mifepristone and misoprostol are now widely available in rural Tamil Nadu, India, and the practice of abortion is being transformed. This paper reports on current attitudes and practices concerning medical abortion among qualified abortion providers in a rural area of Tamil Nadu. Interviews were carried out with a purposive sample of 40 doctors, 15 informants at chemist shops, 10 village health nurses and 23 women who had recently had an abortion. Twelve of the 37 private doctors who were providing abortions, were providing medical abortion to 70–80% of their patients and 12 others to a selected minority. Eleven had largely rejected it and still used D&C; two had never heard of it. A number of doctors were using misoprostol for cervical dilatation prior to D&C. Some doctors and women who were concerned about incomplete abortion and heavy bleeding did not have a clear idea of what normal bleeding with medical abortion was. Incorrect regimens with second trimester medical abortions might have been responsible for cases of excessive bleeding. Most chemist shops said they were selling the tablets only on prescription, but doctors reported widespread over-the-counter sales. Medical abortion appeared to be quite acceptable to most women, and women were increasingly requesting it. Mechanisms are needed for sharing information about medical abortion among professionals, community health workers and rural families. The state government should develop a comprehensive plan for incorporating medical abortion into the public health system. La mifépristone et le misoprostol, médicaments abortifs, sont maintenant largement disponibles dans l'État rural du Tamil Nadu, en Inde, et la pratique de l'avortement en est transformée. Cet article examine les attitudes et pratiques actuelles concernant l'avortement médicamenteux parmi les prestataires qualifiés pour réaliser des avortements dans une zone rurale de l'État. Des entretiens ont été menés avec un échantillon de 40 médecins, 15 pharmaciens, 10 infirmières de village et 23 femmes ayant récemment avorté. Douze des 37 médecins privés qui pratiquaient des avortements utilisaient la méthode médicamenteuse sur 70-80% de leurs patientes et 12 autres sur une minorité choisie. Onze avaient rejeté cette méthode et recouraient encore au curetage ; deux n'en avaient jamais entendu parler. Un certain nombre de médecins utilisaient le misoprostol pour la dilatation avant le curetage. Des médecins et des femmes qui craignaient un avortement incomplet et de forts saignements n'avaient pas une idée claire de ce que sont des saignements normaux après avortement. Les pratiques erronées avec les avortements médicamenteux du deuxième trimestre sont peut-être responsables des cas de saignements excessifs. La plupart des pharmaciens ont affirmé ne vendre les comprimés que sur ordonnance, mais d'après les médecins, les ventes libres étaient fréquentes. La plupart des femmes acceptaient l'avortement médicamenteux, et elles le demandaient de plus en plus. Des mécanismes doivent diffuser l'information parmi les professionnels, les agents de santé communautaire et les familles rurales. Les autorités de l'État doivent préparer un plan global pour inclure l'avortement médicamenteux dans le système de santé publique. La mifepristona y el misoprostol, fármacos utilizados para inducir el aborto, ahora están ampliamente disponibles en Tamil Nadu, en la India, y la práctica del aborto se está transformando. En este artículo se informa sobre las actitudes y prácticas actuales referentes al aborto con medicamentos entre prestadores calificados de servicios de aborto en una zona rural de Tamil Nadu. Se realizaron entrevistas con una muestra de 40 médicos, 15 boticarios, 10 enfermeras del poblado y 23 mujeres quienes recientemente habían tenido un aborto. Doce de los 37 médicos privados quienes prestaban servicios de aborto estaban efectuando el aborto con medicamentos en el 70–80% de sus pacientes, y 12 otros en una minoría. Once lo habían rechazado y aún usaban el legrado uterino instrumental (LUI), o D&C; dos nunca habían oído hablar al respecto. Varios médicos administraban el misoprostol para la dilatación cervical antes de efectuar el LUI. Algunos médicos y mujeres que expresaron inquietudes sobre el aborto incompleto y un sangrado abundante no sabían bien qué es un sangrado normal durante el aborto con medicamentos. Regímenes incorrectos para los abortos con medicamentos efectuados durante el segundo trimestre posiblemente fueron responsables de los casos de sangrado excesivo. En la mayoría de las boticas afirmaron que estaban vendiendo los comprimidos sólo con receta, pero los médicos informaron frecuentes ventas sin receta. El aborto con medicamentos pareció ser muy aceptado por la mayoría de las mujeres, quienes lo solicitaban cada vez más. Se necesitan mecanismos para compartir la información pertinente entre los profesionales, trabajadores comunitarios de salud y familias rurales. El gobierno estatal debería formular un plan integral para incorporar el aborto con medicamentos en el sistema de salud pública.

This paper reports on a community-based study in 2001–02 in a rural district of Tamil Nadu, India, among 97 women who had had recent abortions, to examine their decision-making processes, the types of facility they attended and the extent of post-abortion complications they experienced. The 36 facilities they attended, both government and private, were ranked by 18 village health nurses, acting as key informants, as regards safety and quality of care. Three categories – qualified and safe, intermediate or unqualified and unsafe – were identified. Most of the providers were medically trained, and 75 of the 97 women went to facilities that were ranked as high or intermediate in quality. Government abortion services were mostly ranked intermediate in quality, and criticised by both women and village health nurses. There has been a substantial decrease in the numbers of traditional and unqualified providers. However, about 30% of the women experienced moderate to serious post-abortion complications, including women who went to facilities ranked high. We recommend that government facilities, both the district hospital and primary health centres, should improve their quality of care, that unqualified providers should be stopped from practising, and that all providers should be using the safer methods of vacuum aspiration and medical methods to reduce post-abortion complications. Une étude communautaire réalisée dans un district rural du Tamil Nadu, Inde, auprès de 97 femmes ayant récemment avorté a examiné leurs processus de décision, les types d'installations fréquentées et les complications après l'avortement. Les 36 centres, publics et privés, utilisés par les femmes étaient gérés par 18 infirmières de village qui servaient d'informatrices clés pour la sécurité et la qualité des soins. Trois catégories – soins qualifiés et sûrs, intermédiaires ou non qualifiés et non sûrs – ont été identifiées. La plupart des prestataires avaient suivi une formation médicale et 75 des 97 femmes s'étaient rendues dans des centres de qualité élevée ou intermédiaire. Les services publics d'avortement étaient généralement de qualité intermédiaire, et critiqués par les femmes et les infirmières de village. Le nombre de prestataires traditionnels et non qualifiés avait nettement diminué. Néanmoins, près de 30% des femmes avaient souffert de complications modérées à graves après l'avortement, même celles qui étaient allées dans des centres bien classés. Nous recommandons que les centres publics, aussi bien l'hôpital de district que les centres de soins de santé primaires, améliorent la qualité des soins ; les prestataires non qualifiés devraient être interdits de pratique et tous les praticiens devraient utiliser des techniques plus sûres comme l'aspiration et les méthodes médicamenteuses pour réduire les complications après l'avortement. Este articulo informa sobre un estudio comunitario realizado en un distrito rural de Tamil Nadu, la India, en 97 mujeres que habían experimentado un aborto reciente a fin de analizar sus procesos de toma de decisión, los tipos de establecimientos de salud que consultaron y el grado de complicaciones postaborto que presentaron. Los 36 establecimientos de salud, tanto gubernamentales como privados, fueron clasificados por 18 enfermeras del poblado, como informantes clave, respecto a la seguridad y calidad de la atención. Se establecieron tres categorías: calificado y seguro, intermedio o no calificado e inseguro. La mayoría de los prestadores de servicios tenían formación médica, y 75 de las 97 mujeres acudieron a establecimientos de calidad alta o intermedia. Los servicios gubernamentales, clasificados principalmente como de calidad intermedia, recibieron críticas tanto de las pacientes como de las enfermeras. Se ha visto una considerable disminución en el número de proveedores tradicionales y no calificados. No obstante, un 30% de las mujeres presentaron complicaciones postaborto de moderadas a graves, incluidas las mujeres que asistieron a los establecimientos de alta calidad. Recomendamos que los establecimientos de salud gubernamentales, mejoren su calidad de atención, sea prohibida la práctica de los proveedores no calificados y todos los proveedores utilicen los métodos más seguros de aspiración y métodos con medicamentos para disminuir las complicaciones postaborto.

This paper describes main features of a program of technical assistance in South Asia (primarily India) designed to help community health researchers develop more effective data gathering and analysis in applied studies of reproductive health issues. The program was funded by the Ford Foundation (India) and organized under a grant to Johns Hopkins University. Recipients of the technical assistance have been mainly small nongovernmental organizations (NGOs) and some social science researchers in academic institutions in India. In most cases, the participants have been involved in community-based intervention programs, so the research activities have had a directly applied focus. The increasing challenge of the AIDS epidemic brought about a shift in emphasis in the program, as many organizations and individuals took up research on sexual behavior to better understand the patterns of individual actions that are associated with higher risks of HIV infection. An informal \"sexual behavior research network\" has developed as the program of technical assistance and the communications among the various participants matured. The use of computers for data management and e-mail communication has facilitated these developments.

This paper reports on qualitative research on abortion services in the Coimbatore district of Tamil Nadu in south India, and the role of government village health nurses (VHNs) in assisting women to obtain abortions. The aim of the research, carried out in 1997, was to document the process married women go through to obtain abortions in both the public and private sectors, particularly women in rural areas, and why they preferred private clinics. The research consisted of direct observation of “sterilization/medical termination of pregnancy camps” at rural primary health centres and in hospital settings, plus informal and in-depth, open-ended interviews with medical officers, gynaecologists, government medical administrators, VHNs and other health care personnel. It found that VHNs were not only helping their clients to obtain abortions in government facilities but also and more often with qualified private providers. Unmarried girls were excluded from this process by the need for secrecy, however, and were perceived to still be going to unqualified providers. Government records show that there were clear reductions in the availability of public abortion services in the rural areas throughout the 1990s. The widespread perception that private services were safer and treated women better, the increased availability of qualified private abortion providers and the help of VHNs to access private services all encouraged married women to use the private sector. Cette recherche qualitative porte sur les services d'avortement dans le district de Coimbatore dans le Tamilnadu au sud de l'Inde, et le rôle des infirmières de village des services gouvernementaux pour aider les femmes à avorter. L'étude, menée en 1997, portait sur les démarches accomplies par les femmes mariées, particulièrement dans les zones rurales, pour obtenir un avortement dans les secteurs publics et privés, et pourquoi elles préféraient les cliniques privées. Les chercheurs ont observé des “camps d'interruption de grossesse/stérilisation” dans les centres ruraux de soins de santé primaires et à l'hôpital, et ont interrogé des médecins, des gynécologues, des administrateurs médicaux de l'Etat, des infirmières de village et d'autres personnels de santé. Ils ont montré que les infirmières de village aidaient leurs patientes à obtenir des avortements dans les centres gouvernementaux, mais aussi de plus en plus auprès de prestataires privés qualifiés. Néanmoins, les célibataires étaient exclues de ce processus par nécessité de garder le secret et s'adressaient encore à des praticiens non qualifiés. Les dossiers administratifs révèlent que, dans les années 90, la disponibilité des services publics d'avortement a diminué dans les zones rurales. L'idée fréquente que les services privées étaient plus sûrs et traitaient mieux les femmes, la disponibilité accrue de praticiens privés et l'aide des infirmières de village pour accéder aux services privés étaient autant de facteurs encourageant les femmes mariées à utiliser le secteur privé. En 1997 se llevó a cabo una investigación cualitativa sobre los servicios de aborto existentes en el distrito de Coimbatore en Tamilnadu en el sur de la India, y sobre el papel de las enfermeras comunitarias en ayudar a las mujeres a obtener abortos. El objetivo de la investigación era documentar el proceso por el cual pasan las mujeres casadas para obtener abortos, tanto en los sectores públicos como privados, especialmente las mujeres en áreas rurales. Se indagó además acerca de su preferencia por las clı́nicas privadas. La investigación consistió en la observación directa de los “campos de esterilización/aborto médico” en los centros de salud primaria rurales y en hospitales, además de entrevistas informales y a profundidad con directores médicos, ginecólogos, administradores médicos estatales, enfermeras comunitarias, y otro personal de la salud. Los resultados revelaron que las enfermeras comunitarias no solamente ayudaban a sus clientes a obtener abortos en los servicios de salud estatales sino también, y con más frecuencia, con proveedores privados calificados. Las jóvenes solteras estaban excluı́das de este proceso debido a la necesidad de mantener el secreto; sin embargo existı́a la percepción de que ellas recurrı́an a proveedores no capacitados. Los datos gubernamentales muestran claras reducciones en la disponibilidad de servicios de aborto públicos en las áreas rurales durante la década de los 90. La percepción generalizada de que los servicios privados fueran más seguros y que trataran mejor a las mujeres, el aumento en la disponibilidad de proveedores privados capacitados para hacer abortos, y la ayuda de las enfermeras comunitarias impulsaban a las mujeres casadas a utilizar los servicios del sector privado.