ABSTRACT Lithuanian Mercy Lift of Chicago and the University of Illinois at Chicago, WHO Collaborating Centre for International Nursing Development in Primary Health Care, have trained Lithuanian health professionals to be community peer leaders in AIDS prevention. This program, built on the primary health care model and the peer leader model of behavioral change, was eagerly accepted by participants and endorsed by the Lithuanian Ministry of Health. Many of the nurses trained in Lithuania now volunteer their time in AIDS prevention at work, home, and community meeting places. In Lithuania, the National Continuing Education Program will sustain the initiative for nurses. This endeavor illustrates a model for nurse-to-nurse collaboration across national boundaries and guided international consultancy experiences for pre- and postdoctoral research trainees.
An International Primary Health Care Collaboration
THE INTERNATIONAL AIDS PANDEMIC CHALLENGES WORLD HEALTH LEADERS to final AIDS prevention models that are effective, culturally acceptable, affordable, and easily transferable. Community-based peer education for AIDS prevention offers this potential because it: integrates the World Health Organization's (WHO) primary health care (PHC) model and the social learning model of behavioral change promotion. The PHC model is built upon the principles of accessibility, affordability, accept ability, and community participation. It emphasizes intersectoral collaboration to achieve health as an integral part of development (1). The integrated social learning model has been identified by the National Institutes of Health Consensus Panel as highly effective for promoting AIDS prevention behaviors, based on extensive research with many different types of groups (2).
In this report, we describe a unique international collaboration to develop the capacities of Lithuanian health professionals in AIDS prevention through training as community peer leaders. Health professionals are already recognized as authorities on health-related issues in their communities and have regular contact with a wide variety of people. Thus, they are well situated to be effective community AIDS prevention leaders.
This project also provided an opportunity to integrate an international primary health care experience into the educational programs of pre- and postdoctoral research trainees in nursing. Our experience provides important lessons about the process of cross-cultural adaptation of PHC models for health promotion.
The Need for AIDS Prevention in Lithuania WHO has identified Eastern Europe and the former Soviet Union as a geographic area at high risk of an HIV/AIDS epidemic (3). Although Lithuania is currently still a low-prevalence country, the real incidence is far higher than the official statistic of 135 HIV-positive persons. The majority of known cases (85) are in Klaipeda, a major Baltic seaport. Major routes of HIV/AIDS transmission in Lithuania include injecting drug use (63/135), heterosexual contact (28), homosexual contact (33), and undetermined (11) (4).
Many factors favor the rapid spread of HIV/AIDS in Lithuania. Alcoholism, depression, and poverty have been long-standing social problems. Since independence, Lithuanians have contended with a climate of rapid social change, regional political and economic instability, rapid economic growth for a few, and growing income inequality. Drug addiction, alcoholism, prostitution, sexually transmitted diseases, partner separation or divorce, and early sexual activity are all on the rise. Open dialogue about drug use, sexual activities, homosexuality, and HIV/AIDS transmission and prevention is needed.
Lithuania now has open borders with higher-prevalence neighbors, including the Ukraine and Kaliningrad. The country's national health system is gradually moving toward a PHC model, but elements of the bureaucratic, highly centralized culture inherited from the Soviets continue. …