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The World Health Organization (WHO, 2012) reported an annual incidence of 499 million new infections of curable sexually transmitted infections (STIs), and it is estimated that globally 35.3 million people live with human immunodeficiency virus (HIV). In developing countries, STIs are an enormous burden of morbidity and mortality through their impact on reproductive and child health and through their role in the spread of HIV (WHO, 2007, 2012). In Chile, there has been an increase in the number of STI and HIV cases, especially among women between 18 and 24 years of age (Chilean Ministry of Health [MINSAL], 2013), which is similar to trends seen worldwide. Chilean women younger than 25 years have been found to have the highest prevalence of syphilis, gonorrhea, chlamydia, and papillomavirus (MINSAL, 2014; Peredo, 2007; Santander et al., 2009), and a high percentage (45%) of STI-related medical visits (Santander et al., 2009). There are several unique and interrelated risk factors in Chilean young women, such as liberalization of sexual behaviors, multiple partners, drug and alcohol consumption, stigma, intimate partner violence (IPV), and cultural factors, including machismo and marianismo. Machismo is defined as the construction of masculinity and the profile of a man as a provider who is independent, strong, willing to face danger, dominant, heterosexual, virile, knowledgeable, aggressive, and in control of his environment, including women. Meanwhile marianismo derives from the Virgin Mary or “Maria” and denotes the submission of women to men, with the ideal of women defined as being pure, dependent, vulnerable, abstinent until marriage, innocent, silent, and self-sacrificing (Cianelli, Ferrer, & McElmurry, 2008). Culture-related values and patterns such as these may increase Chilean women’s risk for acquiring STIs and HIV by contributing to a lack of condom use, acceptance of infidelity by the male, domestic violence, and the absence of sexual communication and negotiation with their partners (Cianelli et al., 2008; Gonzalez, Molina, Montero, Martinez, & Leyton, 2007). In addition to the unique set of risk factors, there are also barriers to prevention, such as lack of health education, lack of STI and HIV prevention efforts in the educational institutions, long wait times for medical care, and practitioner attitudes and behaviors that may lead to discriminatory practices (e.g., personal fear that they will contract the infection, judgmental attitudes, exaggerated precautions taken when treating a person living with HIV) and that interfere with high-quality prevention, treatment, and care (Chilean Ministry of Education, 2005; Cianelli et al., 2011; Dides, Benavente, & Moran, 2009). Internet-based interventions have the potential to increase interest and participation in STI and HIV prevention programs (Bull, Pratte, Whitesell, Rietmeijer, & McFarlane, 2009; Noar, Black, & Pierce, 2009) and have shown favorable preventive behavior outcomes (Ritterband & Tate, 2009; Swendeman & Rotheram-Borus, 2010). Some of the major advantages provided by Internet interventions include standardization of the content, privacy and anonymity, and easy access to appropriate information from any place and at any time that is convenient. Internet interventions can also reduce obstacles experienced in face-to-face interventions, such as transportation, the cost of a place to meet, and the fear of embarrassment to discuss sensitive topics in front of other people (Ritterband, Thorndike, Cox, Kovatchev, & Gonder-Frederick, 2009; Tate, Finkelstein, Khavjou, & Gustafson, 2009). Based on the promise of a culturally informed STI and HIV prevention intervention for young Chilean women that can address barriers to services, an Internet-based STI and HIV prevention intervention (I-STIPI) was developed and was shown to be highly feasible and acceptable in a sample of young Chilean women (Villegas et al., 2014). This intervention was culturally adapted for Chilean women and represented an innovation in the method of delivering STI and HIV prevention. This is the first intervention delivered online in Chile, to prevent STIs and HIV, that was designed to reduce barriers and to increase participation in prevention programs. The implementation of the intervention was feasible because of the high accessibility of the Internet and broadband connections in Chile, and the regularity in the use of the Internet (86%) among Chileans between 18 and 24 years of age (Godoy, 2011; Internet World Stats, 2013). This article reports on Chilean women’s risk factors and the preliminary efficacy of the I-STIPI as it concerns prevention-related STI- and HIV-related information, motivation, behavioral skills, and preventive behaviors. The findings regarding STI and HIV prevention-related outcomes can be used as a source of information for nurses working in STI and HIV prevention with women or young populations. |
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