Empowering women to negotiate safe sex: a model from Brazil.

In response to the significant increase in AIDS cases among women in Brazil BENFAM a family planning nongovernmental organization developed a group intervention to empower women to negotiate safe sex. Formative research conducted in 1991 to assess the target population revealed that the women understood how HIV is transmitted but perceived themselves to be at low risk if they were faithful to one partner. Furthermore the women were inhibited about discussing sexual issues with their partners and were afraid to broach the subject of condom use. Pilot group sessions were thus developed to create a methodology which would increase risk perception among the women and improve their communication skills with their partners. In May of 1993 the project was implemented in two states and it was expanded to three more in October 1994. In its second year 2466 people participated in the groups with 18% being sterilized women who would not likely seek reproductive health services. The issues discussed include correct condom use sexual fidelity sexual pleasure risk and monogamy experiences with sexually transmitted diseases modes of HIV transmission partner communication womens status resistance to condom use importance of condom use and male participation and responsibility. The use of the group methodology has been highly effective because it allows women to share their feeling and experiences as well as to practice more assertive behavior in a nonthreatening environment.