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Addressing Sexual Health with WIA Every week, the interns prepare a taller on a wide variety of topics. These 'workshops' provide an opportunity for the Women in Action members to learn about a subject that is unfamiliar or maybe intriguing. It allows the interns an opportunity as well to learn from the experiences, insights, and opinions of the women. This dialogue promotes a mutual exchange of knowledge, and the formation of cross-cultural bonds. When we recently asked the Women in Action members if they had any requests for topics to be covered in our next weekly workshop, the responses were overwhelmingly health related. Among the requests were menopause, birth control, STD's, high blood pressure, mental health and depression, nutrition, and cancer prevention. We intended to address the majority of these topics in our first two workshops, without delivering an overwhelming amount of information, and while still offering a space for in-depth discussion and dialogue. The first workshop centered on STD's, birth control, and reproductive health, with the expectation that it would expand to address wider societal issues. Historically, the women have simultaneously requested and resisted discussion of this are of health. This may stem from a variety of factors, including religious beliefs, cultural attitudes towards the body, and discomfort in disclosing private lives. Consequently, even the most thorough education on these topics has seen low receptivity and retention, and open, candid discussion has been virtually non-existent. The issue was not lack of information; the women already knew about different types of birth control and how to obtain them, which is often the bulk of a typical reproductive health workshop. We had a tall order to fill. Instead of providing an abstract and detached overview of sexual health, we had to engage the women by focusing on what aspects of sexual health are pertinent to them; it needed to be personal and jolting. Accordingly, our discussion began with a very blunt description of the symptoms and complications of chlamydia, gonorrhea, HIV/AIDS, syphilis, herpes, trichomoniasis, hepatitis, and human papilloma virus. The women were especially responsive to descriptions of transmission from mother to child, risk of stillbirth, and death during pregnancy and childbirth. Since the women were already familiar with the logic of condom use, the following discussion focused on the continuous lack of use in the community, and the cultural currents involved. The conversation was candid and shocking, yet promising. Some of the women admitted to believing that after a sterilizing procedure, the use of condoms is not necessary. Further, out of the thirteen WIA members present, only one was completely confident that her partner is fully monogamous. Dialogue within a couple about condoms is often restricted for risk of accusing or implying infidelity of either partner. Masculinity is also a feared casualty of condom use, as children, despite their financial demands, traditionally offer concrete evidence of a man’s virility. Testing for STDs presents another barrier in maintaining sexual health among the WIA members. In Nicaragua,


healthcare is free, but several of the women reported missing or delayed laboratory results, and only after paying out of pocket were they able to obtain their testing reports in a timely manner. Other reasons for not receiving regular pap smears include the physical and emotional discomfort of the procedure and not knowing what laboratory tests are being ordered. Despite these concerning patterns and practices, every woman in attendance requested a copy of the STD information we had presented, hand-outs on pap smears and self-breast exams, as well as a packet of condoms. This level of openness and dialogue among this group of women on the subject of sexual health is unprecedented. They were able to speak seriously and comfortably about these issues, thereby breaking down another obstacle to sexual health: lack of dialogue. In a culture perceived as so sexually liberal, it has proven difficult to reconcile a woman’s physical awareness, respectability, sexuality, and autonomy. We were pressing the women to objectify their sexuality, by looking at patterns, transmission, and symptoms, and to simultaneously subjectify their experience in light of the societal and religious forces that characterize transmission. These diseases are, first and foremost, sexually transmitted, but we tried to strip them of their stigma without removing the gravity of the sexual dynamics in this country. Ana, the Compas director who attended the workshop, noted how quickly we had transferred so much information, and she envisioned diseases spreading through the barrio at the same alarming rate. Accordingly, she called for us all to counter the chain of infection and transmission by promoting a chain of healthy and safe practices, transmitting awareness instead of disease and creating a collective attitude that will improve the long-term health of the community. The next workshop will cover diet and nutrition, followed by a workshop and depression and mental wellbeing.  


Addressing Sexual Health with WIA