ZIG-ZAIDS: crea ting alter nat ives for HIV Aids prevention

C_ad. Saúde Púb lica, Riode J_aneiro, 15(Sup. 2):107-119, 1999

E

v

a

lu

a

t ion o f the Z

I

G

-

ZA

I

D

S

g

a

me:

a

n en ter t

a

ining edu

c

a

t ion

a

l t ool

for H

I

_V

_{/ Ai d}

s

p re v e n t i o n

A

v

a

_li

a

_ç

ã

_o

_do

_J

_ogo

_Z

_I

G

_-

_Z

_A

_I

_D

S

_–

u

_m

_r

e

_c

u

_r

s

o

l

ú

_di

_c

_o-

e

_d

u

_c

a

_ti

_v

_o

_p

a

_r

a

_i

n

_fo

_r

_m

a

_ç

ã

_o

e

_p

_r

e

_v

en

_ç

ã

_o

d

a

_A

_I

_D

S

en

_t

_r

e

_p

_r

é

_-

a

_dol

e

s

c

en

t

e

s

1Ce n t ro de Pe_sq u isas Re n é Rachou,Fu n d açãoOswaldo Cruz. Av. A ugust odeLima 1 7 1 5 , B a r ro Pre t o, BeloHorizonte, MG 30190-002, Brasil. vtschall@cpqrr.fiocruz.br 2 La b o rat ór io d e Ed u ca çã o

e mA m bie n teeS a ú d e, Depart a m e n todeBiologia, Insti t u t oOsw a l d oCr u z , Fu n dação Osw al do Cr u z (Centrocol ab ora d orda

UNAIDS/WHO).

Av. Brasil 436 5, Ma n g u i n h o s, Rio de Ja n e i ro, RJ

21045-900, Brasil. Virgín iaT. Sch all1 , 2 Si m o neMonteiro2 SandraM . Rebello2 Ma ysaTorres2

A bst ract _{Th i}sar ticleprese n tst heeva lu a tion processforth eZIG- ZAIDSga m e, investigati ngt he material’sa p p l icab i l i t yi nf o r m ala n di n for m a led ucat i o n alco n t exts, i.e., howt h ega m eh as be enusedby heal t hprofessionals, parents, a n dt het arget p op u lat io n( pre-adolescents, orchil -dre nover9yearsol d). T hest u dyi n volve dev al u a tio nq uest io n na iressenttoal istofschoolsa n d i nstit u tio nsusi ngt hega m e, pl usi n ter vie wsan dvisitst oplacesw heret hega m ew asuse daswell ast estedwi t hgro u psofst u de n ts. Italsoincl u desa na n al ysisofeval uatio npre v io uslyse n tbyt he a ut h orstopeo plew h oh a dreq uestedt hega m e. T heresu ltssh owe dt h att hepop u la tio n_’slevelof i n for m a ti o nism orereleva n tt h a nagei nrela t ion t ot hega m e’si m p act. A n ot h eri m p or ta n tas -pectrelatestoZ IG- ZAIDS’a p p licabili tyt odi ffere n tsit u at io ns:trai n i ngofheal t ha n dteachi ng professionals;activit iesw it hstreetchil dren;m u n ici pali nsti t ut i o nsa ndevents,schools,comp a-nies,communities, a n dh e alt hcarece n ters. I nsu m m ary, ZIG-ZAIDSw asf o u n dtob ea ne n t er-taining,creative, a n d i n n ov ativealter n ati veforprovi di ngi nfor m a tiono nAIDSa n dsexuality. Key w ords _{Heal t h} E_{ducation;Ed uca tiona lTechnology;Eval uatio nofRe}sultsofPreventiveAc -tions;SexBehavior;HIV;AcquiredI m m u n odeficiencySyndrome

Resu mo _Est eart igoa presen t aoproces sod ea v al iaçã od eu m m ateri a le d ucati vo, oj ogoZIG -Z AIDS, q u etevep orob jeti v overi ficaraa plicab ili da ded est em ateriale m esp açose d ucacio n ais for m aisei n for m ais, ouseja, investigarco m ove mse n d ou tiliza doporprofissio na isep ais, ep ela população-alv o( pré- a d olescen tes). Oest u doe n volv e uoe n viod eq uesti o n áriosd eav aliaçã oa escolasei nstit u içõesq u efaz ia m usodojogo, entrevistas, visitasaalgu nslocaiso n deoj ogoesta -v ae musoetest age m co mgr u posdeal u nos. Incl u i uai n d aa n ál isedeav aliaçõese n via dasa n te -rior m en tepelasa u torasasolicita nt esdojogo. Osresult adosd e m onstrara mq ueon íveldei n for-m açãod apo p u l açãoém aisreleva n tedoq u eai d ad ee mrelaçãoaoi m p actod ojogo. Outroas -p ecto dest aca d orel acio n a-seàa p lica bil i d a d edo Z IG- ZAID S asi t u açõesd i versas,como:em trei n a m e n tosdep rof issio n aisdee nsi noesaú de;e m at i v id adesco m m e n oresqu evive m n ar u a; e m e ve n t osd ep refeitur asei nst i t u ições, e mescolas, empresas,co m u n i d a d esepostosdesa ú d e. Sintetizando, oZIG- ZAIDSfoico nsid erad ou m aalter n ativ al ú d ica,criativaei novadorap arai n -for m arsobreAIDSesexualidade.

A

I

D

S

a

_mong

c

_{hild ren}

a

_{nd youth in}

_B

_r

a

z

_il

Alt h o ught h e reisco nsid era bleu n de rreporting i nBra zilrela ti ngtoAIDS_{,ot h er}S_{TDs,a n ddrug}

a bu s ed uringad ole sc e nce,severalst u dieshave show n t h a ti niti al sexu a la ct ivitya n dexp e

ri-m e n t a ti o n wit h diffe re n t ps ychoactive s u b -s t a n c e -sge n e r ally o cc u rs b e tw e e n 10 a n d 19 ye arsofage.Ass uggeste dbyS_{a n tos(1996),}

de-s pitet herelativelysm alln u mb erofAIDS_{c a ses}

report edinBr azilint h e15-19yearagebracket asofAu g u st1995(1,633),give nth el on gi n c u-b a tio n pe r io d ,t h e r esig n st h a ti n divid u als di-ag nos edwit hAIDS_{at20to29yearsofwere}

ac-t uallyi nfec t edd u ri n ga d olesc e nc e,reinforcing t h e n ot io nofvu l n er a b ili tyt oS_{TDsa n d d r ug}

a bu sed u ri ngt hiss tageoflife.

As of Au gu st 1998, a c u m ula tive t ot a l of

140,362AIDS_{c a se sh a db ee nrepor t e di nBrazil}

s i n c e 1980 (MS_{, 1998).T he m os t sign ifi c a n t}

HIV_{exp os u reca t egoryi np e opleove r12years}

ofa gew a ssexu alc o n t a c t(64%).Th eva s tm

a-jorityofca se sexp ose dt oc o nt a mi n at e dblo o d

(12.9%ofatotalof13%)wereintrave n ou sdr ug users.Am on gi n d ivi d u alsu n d e r13,p e rinatal tr a n s m iss io n a cc o u n t e d for 89.3% of i nfe c-tions.Int h e15-24-ye aragegroup,18,271cases ha db e e nrepor t e d,cor re s p on di n gt o13.1%of

t hec u m ulativet ot al,whilet he25-39agegroup a cc o u n t e dfor59.7%.Du etoH IV_’sp rolonged i n c u b atio npe riod(a p p roxi m a t ely8- 10years),

o n ec a nco n cl u d et h a tas ign ific a ntp or tio n of

i nfe ctio n socc uri nyouth.

Accor di ng to r e c e n t d a t a fr o m U NAIDS_/

W_{HO(1998),n e wc a se ske e pa p pe a r in gatt h e}

s a m eori n crea s e dra t esi ns o m eco u n t ries,re -quir in gfur t h e ri nv est m e n tinp reve n ti on .A c-cor di ngt oU NAI DS_/WH O(1998),t h en u m b e r ofp e o pl ewit hHIV/Aid swo rl d wi d ei n creased by10%i n1998.Halfoft h en e wi nfe c ti o n so c-curredi nin divid u als15t o24yearsold.

Ot h erd a t a p oi n tt ot he oc c u rre n ce ofu n -pr o t e ct e ds exu a la c tivi tya m o n gyo u t h ,a sd o

t he d at a o n t e e n a ge p re gn a n cy ( u n d e r 19), w h ic hocc ur si n13%ofBr azilia nfe m a les.A c-cor di ng t o d a t a fr o m t h e Ministry ofH ealth (1996),23.44%oft h e2,821,211birt h sas sist e d b yt h e U n ifie d H e al th S_{ys te m (}S_US_{) i n 1995}

wer ei n m ot h e rs15- 19ye a rsofag e.I nRi od e J_{aneiro,17%oflivebir thsin1994wereinmoth} -e rs fr o m 1 2t o 19 ye a r s of a ge, or a t ot al of

15,697ba bies.Oft he sem ot he rs,60%were illit-era t eorhada nin co m pletep rimar ye d uc atio n, r einforcingt h easso c iatio nb e twe e ns ex- rela

t-e dbe haviora lvuln erabilitya n dge n d era n d so-cialfact ors,i.e.,lessa ccesstosch o oling,inf or-m a tio n,a n dt h ea bilityt oa ccessa n d us ec o n -traceptivem e t h od s.

D emogra p h i cs t a t i s tic so n H IV_{t r ansmis}

-sio ni nt he1990sp oi n tt ot h ei nc re a si ngn u m -b e r of AI DS _{c a s e s i n w o m e n ( of t h e 79,906}

cas e sr epor t e da s ofFebruary1996inBr azil, 14,464,or18%,w er ewo m e n).Th ish a sa ni n -crea singi m p a cto nt h eprevale nc ea m on gc hil-dre n: 78.3%of p e dia t r icAI DSc a s es resulted

fro mver tic altra n s m issio n.Inad dition,co nsid -eri ngt hei ncrea s edm ea nsu rvivalti m eforp eo-ple wit h AIDS _{d ue to c o m bi n a tio n t h e rapy,}

m a n yH IV-positivec hild re n a r e n owi n e a r ly a d ole s c e n c e a n d b e c o m in g sexu ally a c tive,

he ncer equiringsafersex/ preve n tion m eas ures

int h eirr elationships.

Z

I

G

_-

ZA

I

D

S

:

c

re

a

t ing

a

lter n

a

t ive

s

for H

_I

_V

/ Ai d

s

prevent ion

Thep ro p osaltopr o d ucee du ca tio n alm a terials onHIV_{/Ai dspr eve ntio na m ongyo u t hb egani n}

1988, wit h t h e r eperc u s si o n s of t h e gr owing n u m b e rofAI DS_{c a se si nt h ege n e ra lp o p ul a}

-tio n.Alt ho ught hefirstca s eswerei de ntifie di n ho m os exu alm al esint heUnit edStatesin1981,

d u et oh o m op h o biaa n dp reju dic eo nt h ep ar t ofgover n m e n t ali n s tit u ti o n sa n ds e g m e n tsof

civilsocie tyb ot hwo rl dwi d e(S_{hilts,1987)a n d}

inBrazil(Da n iel&_{Parker,1991),t he r ewa sun}

-necessaryd elayinfo r m ula tingp oliciestost e m t hegr owthoft h eep id e m ic(M a n ne tal.,1993). Contr over sy c o nc e r n i n g t h e o rigi n a n d tr a n s m iss io noft h eHIVa n dt h el a ckofm e d i-ci n esa n d va c ci n e s c a p a b le of r e d u ci n g H IV

tra ns m issio nha dc o ntrib ut e dt oafa talist,p re j-u dic e d,a n de rr o n e o u svie woft h e di se as e.It wa st h usim por ta n ttoch a nget h ep ro po salss o astop ro m o t ei nfor m a tio nt h atm igh te nc o ur -agep r eventivepr actices.Aro u n dt h isti m e,a n ex tensive s ur vey c o n d u c t e d by S_{c h all e t al.}

(1987)o nh ealt hissuesa m ongst ude n tsin cl ud -edquestio nsaboutele m e ntaryst ude n ts’know l-e dg l-eofAI DS_{. An swe rs by36 5s t u d e n tsfr om}

tw oBrazilia ncities,RiodeJ_aneiro(RJ_{)a n dBe} -loHorizonte,i d e n tifie dm isc o nc e p tio n s,ign o-r ance,a n d afa t a listvie woft h ee pid e mi c(Re -b ello e t al.,1989).T he se d a t a c o nfi r m e d t h e import a n c e of i d e n t ifyin g e d u c a ti o n a l a p -pr o a c h e swit h c o n t e n t s c a p a ble of fos t e ring preventivep ractices.

Meanwhile,a na n alysisofth elit erature,t he m e dia,a n dAIDS_{-r elat edn o ngover n m e nt alor}

-ga niz a ti o n sp oi n t e dt ot h en e e dforBr azilian e d u ca tio nalm a te rialsfoc u singonHIV_preven

-tio na m o ngc hild re na n dyo ut h.Ina dd itio n,i

n-for m a tio n p r ovid e d byp u b lich e a lt h d e p a r t -m e nt sa n dt hem e dia(Carrar a&_Moraes,1986)

C_ad. S_aúde Púb lic_a, Riode Janeiro, 15(Sup. 2):107-119, 1999 e d u c a t io n al. Th e over w he l mi ng i m p ression

fr o mAIDS_{p reve n tio nca m p aig nswa st h atofa} fa t al dis e as e.I n t h eli t e r atur e, r esearc h c o n

-fir m edt heres ultsofo urinvestigatio nwit hs tu -d e n t sa st ot h ela c kofi nfo r m a ti o na n dwid e-sprea dmisco nc eptio ns(Pi n h oetal.,1989),be -si d e sh ig h lig h t in gt h ec h alle n ge sofa d o p ti ng preventivep r actices,giv e nt h e c o m plexit yof

is s u e s i n volve d i n AIDS_{, like sexu a lity a n d}

d e a t h ,w hi c hh a vea lw aysb e e n t a b o od u ring c hild h o o d .T h ela ckof dia lo gu e o n t h ei ss u e s te m m e dfr o mth eexclusionofto picst ha tn

ei-t h erfa milyno r sc h o olfo u n dp r o p erfo rc hil-dre n,main taini ngas ortoftra ditio n alm orality, har dlyc o n s tr uctiv eo rp reventive.According t oa n ot h e rp revaili n gn ot io n ,t osp e aka b o u t s ex or d r u gsw it h c h ild re n a n dyo u t h m ig h t in d u c et h e mt ot r yd r ugs ,ifs u c his s u e swere br o u gh t u p o u t si d e t h e fa mily, sc h o ol, a n d h ealt hp r ograms.

S_{i n ceth ea dve ntofAID}S_{,s ocietyitselfa n d}

t hepolitic alp owerb et we e nth eid eologic alre -pr e s si o n ofsexu a li tyi n si d e t h efa m ily (o n c e

privatizedbyt hes ocialm od el)b ega ntose arch

fo ral t er nativep e d agogic ala p p ro a c he stot his q u estio n,o bservingth enee dform or eco m m u -nic a tio na n dp ressur edbyAIDS_{’p ot e ntialrisk}

t olife a n d he a lt h . I n s h o r t, b o t h t h e s u r vey a mo n gstu de n tsan dt helite raturea n alysiss ug-gest e dt hei m p o rt a n ce ofcr ea ti ngpe dagogical r esourc esi nt h eHIV_{/Ai d sp reve n ti o na r e at o} fo st erle a r n in ga n dd e b a t ea b o u tt hee pi d e m -ic’ss ociala n dsym b olicasp ects.

T

he Z

_I

G

_-

ZA

_I

D

S

g

a

me:

t h e o ret i

c

a

_{l b}

a

s

_i

s

a

_{nd development}

ZIG-ZAIDSwasc re a te di nt heco nt extofala b

-oratory(th eHealt ha n d Enviro n m e n tal Educ a-tionLa b oratory–LEAS_{–inth eBiologyDepar t}

-m e n ta tIn s tit u toOswal doCruz/Fu n d aç ãoOs -wa ld oCr u z –I OC / FIOCRUZ) fo cu s e d o nr e -searc h a n ds tr a t egie st od evel o pe d u ca ti o n a l materialst op r o m o t edi s e as e p r eve n tio na n d h ealt hpro m otio nfr o mchild h o odo nwa rd.The researc hc o n s id e r st h en e e dt ost im ula t edia -log u e a n d exc h a n ge of kn owle d ge b e tween

a d ultsa n dc hil dre n,a n da m ongchildre nthem -selves,co nsid erings uc haspec tsasself-esteem, r es p e c ta n dr e sp o n si bilityt owar d so n e’sown lifea n dt ha tofo t h e rsa swella sn a t u re,a n da c o m m i t m e n tt oi m pr ove dq u a lit yoflife.The startingp oi ntisa nat te m pttou n d ersta n dh ow childre nc o ns t ru ctt h em e a ni n gsofh e alt ha n d dis e as ein t he irow nc o n t ext,i n t e r a c ti ngwit h

u niqu ei n divid uala s p ectss u cha ss elf- est e e m , pr io rexpe r ience,a n dfa m ilya n ds c h o olrela

-tio ns hi p s(S_{ch all,1996).Ina d ditio n,t h ei nt e}

r-vi e ws a n dq u es ti o n n a ir e s p rovid e ab asisfor o b taini ngbe tt e rkn owle dgeoft heinfor mation leve la n da p p r opri a t ela ngu agefo rt h et ar get p o p ul a ti o n.At h e ore ti ca lb a sisi se ss e n ti alt o pr ovid es u p p or tfo re d u c a tio n alpr a ctic e sa n d ne wm a te rialsd evelo pe datLEAS_.

V_{ygotsky(1991,1993)u nd erliest hisc urrent}

appr o a c ht owar dsdiffe re nt p r oc e s se sofla n -gu agec o n stit u tio na n dco n c e p t s,c o n sid e ring children’ss p o n t a n e o u sc o n ce p t st oward st h e constr uctio nofscie ntificco nce p ts.Thisishelp

-fuli nt h ec o n s t ru ctionofus efullifeskills.This appr o ac hisfoste re dbyt hega me’sowndy na m-ics,inwhichm isco nc e p tio n sarere pla ce dbya knowle dgeb uiltcolle ctivelyt hr oughco nversa -t io na n dc o o pe r a tio n .In d e vel o p i n gt h e n e w materials,wec o n si d e re dw ha tV_{yg os tkyp r}

o-p o se sr egardi ngt h ed evelo p m e ntofhighe ri n-t ellecn-t u alfu n ctio nsa sth ereflex ivec o n scio u s-n e ssa n ddeli be ra tec o n troltha t,on cea d de dt o t h en otio noft h ep roxi m a ld evelo p m e n tzone,

m ig h t h el p p ar e n t sa n ds c ho ols t oovercome t h erequire m e n tsfixe ds olelyt ot h ehi e rarchy

ofm e nt alagea n dt ogras pt h ec hildren’sp ossi-bilities,co nside ri ngth eco o pe rationprocesses. Adialogic alr ela tio n isa d d e d t ot h en ece s s a ry cooper a ti o n a m o n gp a r t n er si n t h e ga m e a s prop ose dbyBakh ti n(1985),favoringa nelab o-ra tio nofm e a ni nginh e alt h / dise a s e,m a kin git p oss iblet oa t t ai naco m plex m e a ni ngb eyond t h eas s ocia tio nli m it e dt ot hebi ol ogic alb o dy a n dac hievi ngs oci ala n daffec tivewell-being, res p ect,a n dtole ra n c ei nh u m a nrelationships. Inad ditio n,itp ro m otesresp o nsibilityfore nvi-r o n m e n t alp reser va tio n,overc o mi n gn o t io n s

fo c u si n go nlyo ni m m e dia t ereality.Thus,s ci-e n tifickn owledge,o n c eb uilt,isn o trestricted t om e morize dd efinitio ns,ra th e rhe alt hm ea n-i ngsa rei n t e rlin ke dwit hot h eras p e ct sofd aily life,m ixi n gu niq u ep oi n tsofvi e wwit hc ollec

-tivep e rs p e c t ive sc o n soli d a t e dbyb o t hc ogni-tivean daffe ctivea sp ects(S_{c hall,1996).}

It m us t als o b e e m p h a size d t h a t i n t h e pr oce ssofd evelo pingt h eZIG-ZAIDS_{ga m eth e}

argu m e nt sdescri be da b ovewerear ticula t eda s cr itic a la n a lys es of t h e li m i ts of t h e c ur rent p oli cies i n t h e fi eld of p rev e n ti o n t h a t wer e b as e ds olelyo nbi o m e dic alinfo r m a tio n ,i n di-vi d u a lresponsibility,a n d / or a na la r m is ta n d

Th is a n a lyti c al p er s p e c tive isli n ke d t o a give nc r itic alvisi o nofe d u c a tio n(Melo,1993) t h a tinflu e n c esdisc u s si o n oft h ee d u c a t io n al natureofp r eve n t io nwo r kin t h eh e alt hfi eld a n dc o n se q u e n tlyt hed evelo p m e ntofm at er i-als.T hisfo cu sisb a s e do np r o p o salsbyFreire (1979)ont h eroleofed u c a tio ni ns o cialt ran

s-for m a tio n,i nw hi c ht hefo r m e rre l at e st ot h e awareness-r a isi n g p r oce s s ch a racterize d by per m a n e n tcri ticala c tio nbyh u m a n st owards reality.Usi ngt hist h eoreticala p pro ach,t hisa u-t h orq ue stio n sp e d ag ogic al,d o m estic a t e d a c-tio nsc e n te redonth ee d u ca tor’sa u t h oritya n d kno wle dg ea n dp r o p os esali b e ra lc o n ce p tof

e d uc a tio n,w h e ree d u c at ora n de d u c ate dpa r-tici patea n dc olla b orat einthele ar ningprocess, i narela tio nu si ngdialogu ea n dp roblem-sol v-i ng.Th ist h e o re tic alo rie n t a t io ni n t r o d u ce s a p olitica la n d s o cia ld i m e n si o nt o e d uc a t io n , exp a n din gt h ed isc u ssio nofle a rn inga n da n a

-lyzi ngt h e p rior ityoft h e c og n itive a n de m o-tion aldevelo pm e ntoft h ep ers ontobee d uca t-e d .T hisp er s p e ctiveisd is c uss e dbyMonteir o (1995) a n dPaiva(1996)w h e np la n n i n gHIV_/ Aids preve ntio np rograms.

Ba se do nt h e se pers p ectives,t h epr ocessof

cre a ti ngZIG-ZAIDS_{w asc h ar acterize dbyc o}

n-t e n n-tsel ectio na n dc h oic eoft h em a t e rial’sa p -pr oa c h.Weatt e m pt e dt odiffe re n tiat et h ec o n-t e n n-tfro m t he p reva ili n g al ar m is tvie w oft h e e p i d e m i c,h ighligh ti ngexp la n a ti o n si d e n tif

y-i n gt h epo ss ib ilityofs afe rsex p r actices,c o n -sideri n gt ha ts exu a la wa re n e s st a ke s p la cei n

pr e - a d ole s c e n c e a n d a d ole sc e n c e, a n d t h a t t hisrequire ssym p at h eticat tit u d es.

Inrel atio nt ot h ea p pr o ac h,d u et ot heta r -ge tp o p u la ti o n’ss p ecific ity,wet r ie dt oi n c or -pora t ee n te r ta in i ngele m e n t sc a pa bleofm oti-va ti nglea r ni nga n dstim ulati n gt hinki nga b o u t t h eepide mic’ss ocia la n dsy m b olica spe cts.W_e t h u s o p t e d t ocr e a t e a q u e sti o n - a n d -a ns wer ga m e(whic hwen a m e dZIG-ZAIDS_{),u singa}

c-cessiblela ngu agea n dexploratoryillus trations

wher e t h e p a r tic i p a n t s g o t i nfo r m a t io n a n d wo uldb em otiva t edt ot alka bou tdiffe re n t sci-e ntifica n ds ocialas p ect softh ee pid e m ic.

ZIG-ZAIDS_{c onsistsofaboardwit h23num}

-bere ds p ac esa n do th e rs p a ce sill us tra te dwit h aco n d o m(“wildc ards”)a n do th e rswit hdire c-t io n ss u c has“goo n es pa cefor war d”,“goo n e sp aceb ackwa rd”,a n d“wait”,twodice,six ga m e pieces,23n u m b eredqu estionca rds(wit hque s-t io n so no n esi d ea n da n s we r sa n ddirections

for t h e n ext m oveo n t h eo t h e r) a n d 20wild

cards.T h e q u e s ti on c a r d s d e a lwit hs u bj e ct s s u cha sth ei m m u n esyst e m ,tra ns m issio np a t-terns,t rea t m e n t,a n dp reve n tio n.Th en e e dfor solidaritya n dco o p e ra tio ni nh u m a nrelation

-shi psise m p h asized.Unlikeot h erga m es,t h ree qu estio nsa skforopi nio nsra t h erth a nright-o r-wro nga n sw ers.Byaski n ga b o utvisitst oAIDS

patients,t heim p orta nc eofsolida rity,a n dp ar -ticip a tionbychildr e nwithHIV_{i nsc hoola}

ctiv-ities,t h ega m ec re a te sop p or t u n itie sfor play-e r st or efle c t o nt h es oci ala n dp sychological co n se q u e n cesofAIDS_{.Thewildc ar d sc o n t ai n}

infor m a tio no nt opicssu chasHIV_{,he m o p hilia,}

blo o dtr ansfusions,d r ugs,jo bo p p or tunities, ne wtreatments,a n dot h e rsubje ctsreleva n tt o pe o plewit hHIV_.ZIG-ZAIDS_{fur t h e rc o nt ain sa}

leafle tforp a re n tsa n dt eac h ers,posi ngdisc u s-sio nq u e sti o nso nt op ic ss u c hast h ediffic ulty an ddisco mforta d ultsexpe rie nc ei ndisc ussing

s ex a n d t h e i m p or t a n ce ofl ist e n i n g t ow h at childre nfe ela n dt hi nka bo u ts ex.Al soin clu d

-e da ream i n i -d ic tio n ar ywi t hw o rdsreferring t os ex o rgans,sexu alr elationships,a n dST Ds.

Thereisalsoas u gge stio nt oi n clu d eac o n d o m ast h efirstp rize,a n dt hereco m m e n da tiont h at itb eop e n e da n ds how nt ocla ss m a tes.

I nor de rt om a tc ht h em a te rialt ot h et arget population’s reality, t h e p r o d u ct wa s te s t e d thr o ug h a n exp e r im e n t i n cl u din gi n t e rviews

beforea n daft e rpl ayin gt h ega m e,i na d di ti o n t odi rec to b s e r va t io n .Usi n ga t es tve r sio n of

t h eg a m e,w eo b s e r ve ds ever a le p is o d eswi t h elementaryst u d e n t sfr o m p u bli ca n dp rivate sc h o olsi nRi od eJaneir o.Th e s e e p is o d e sa l-lowe du st overifyt h ega m e’sc a pa cityt om o ti-va tele a r ninga n dp rovi d e su swit hti pstoa lt e r an da dju stit(Monteir oetal.,1990;Monteir oet al.,1991).

Ba s e do nt h ed a t afr o m t h e t e stga m e,we develo p edt h efi nalve rsio n.Att h isst age,r ules werec h a nged,la ngu agea da p te d,an dnewcon -t e n -t si n cl u d e d.Weals oe val u a t e dt h e ga m e’s n e wvis u a l layo u t , p r o d u c e d byexp e rts.Be

-si d e st es ti n gt h eg a m ewit hst u d e n t s,wea ls o considere dp a rents’a n dte ach ers’o pin io n s. In-terviewswit ht h elat te rle dtoth ep rod uc tionof

am a n u al(i n c lu d e d wit ht h e ga m e )ta rgeting pare n t s a n de d u c a t o rs, wit hs ugge sti o n s fo r a d dition alr ea di ng,t ea c hin gac tivities,a n da d -dre ssesofgover n m e nt ala n dn o ngovernmental in stit u tion sworkingwit hHIV_{p reve n tiona n d /}

ortre a t m e n tfor p eo plewit hHIV/Aid s. O n c et h efi n a lve r sio noft hem a t e ri a lw a s develo p e d,weatte mp te dt oid e n tifyp ublis h ers orc o m pa nie st h a tmigh tb ei nt e r es t e di np ro -d uci n gt h ega m eo nac o m m e rc ialsc a lei nor -de rt om a rke ta n ddist r i bu teit.Morede t ailo n thisst ageoft he m et ho d ologyh asbee nprovid -edbyMonteir o&_{Re b ello(1999).}

Th eZIG-ZAIDS_{gam ewasdevelope dfr o ma}

-C_ad. S_aúde Públic_a, Riode Janeiro, 15(Sup. 2):107-119, 1999 sources,si n cewefeltt ha tt hega m ea sa ned u

-c atio n alresourc ew asco m p let e,b utdidn otre -pl a c et e a c h in g i n p ractice .I n t h iss e n se ou r c o m m it m e n t wa sn o to n lytoc o n c e n t r a t eo n t h ega m e’sscie n tifici m pa ct,b utalsot oevalu -a t e it si m p a ct in t h e s e a rc hfo r p a r tnerships th a two uldfos te racc esst oitsu se,i.e.,te ac hing i ns tit u tio nsa n dh e alt hp rofe ssio n alsi nvolved inp reve n tio ned u ca tio n(Monteir o,1998).

Itisco m m onlyfeltt ha tt h ep ro d u ctio nan d evalu a tionofe d u ca tio nalm at e r ialssh o u ldb e co m bin edwithtrai ni ngofh u m a nresourcesto a ugm e n tt hem a t e rial’se d u c a tio n alp ot e n tial. W_{ese et hega m easate ac hingaid,a n dn otasa}

re plac e m e ntfo re d uc a tio n ala ctivity.Ba se don t herela t e dlit er atureo nchild re n(S_{c h all,e tal.}

1987;Sch all,1996;1999),e n tertainingeducatio n-alai dslik et h eZIG-ZAIDS_{g a m e( Monteir oe t}

al .,1 991)a n dt h eJ_ogod aO ndag a m e (o rt h e “WaveGame”)(Rebello&_{Monteiro,1998)foc}

us-ingondr ugpreve ntion(Monteiroetal.,1994)ca n bes ee ntopl aya ninfor mativerolea n dt oser ve asexcelle ntinstr u men tsforinitiatingdisc ussions

a n dr aisinga wa re ne sso nh ealt h -rela tediss ues.

T

he nee d t o ev

a

lu

a

t e edu

c

a

t ion

a

l

s

_{t r}

a

_{t e g i e}

s

Eva l u a ti n ga ne d u c a tio n a la c tivi tyc a na ss e ss previo us a n d b as eli n e m e a s u res i n or d e r t o eval ua t et h ec h a n geac h ieve d. Eva lu a ti onc a n al sob e us e d t om e a s u r ea n e d u c a ti o n a lp ro -posal’sfea sibilitya n drea c h,recordi nga n da n -alyzi n gitsa p plica bilitytoth epro p ose dte ac h -ingsit uatio ns.

Ou reval u a tio nai m e dt ov erifyt h equ ali ty of i nt e r ve n ti o n i n volve d i n t h e ZIG-ZAIDS

ga m ei nvariou ssit uatio ns:fro ma ninitialsitu -a t io n -ala n a lysis, w h ic h s h ow e d t h e n e e d fo r edu c a tio n alma t e rialo n S_{TDs /Aid st a rgeting}

you th.Thep roc essth usi nco rp ora tedele m e n ts

fr o mt hissit uatio nalevalu a tio n,a t t e m p ti ngto inves tig at et h eg a m e’sa cc e p t a bility,foll ow ed bya neval u a ti o n of t h e p rocess,c on s id e ring th eq ualityoft heh e althe d uc ationprac ticem o-tiva te dbyt h ega m ea n ds ti m ula ti ngdifferent alter nativesa n din- d e pt hco nsid era tio n.Italso in cl u de da ni m p ac tevalu a ti o n o nt h eeffic a cy i np ro m o tin gkn owle dge - b u ildi n ga n dcritical reflec tio n c on ce r ni ngsym b olica n ds o cia la s-pe ctsoftheAIDS_{e pid e mica m o ngadolesc e nts.}

Th e selevelsofeval u atio nh aveb e e nin t er -pr e t e d i n diffe r e n t wa ys by var io us a u t h or s. Ayre s(1996)m ak esa ni n t e r es ti n ga n a lysi sof

t h e eval u a ti o n of e d u c a ti o n a l in t e rvention a m o ngst u d e n ts,relat e dtot hea nalysisofthree pri n ci p le s:1)r e alis m ,w h e ret h ea u t h orle a d s

t here a d ert oco nclu d ei nfavoroftherelevance ofevalu a tio nc riteriaforre alexp e rie nce;2)f e-cundity,h ig hligh ti n gt h ei m p or t a nc eof“p ro-d uci ng a w are n ess ofw h a t is effect iv ely be i ng done”(Ayres,1996:3)fro madiffe re nt ia ti onof t he el e m e n t sw hic h d e t e r m i n et h e in t e rven -tion’ss u cc e s s;3)p racticability, exp r es se d by

t hedefinitionofo bjectivem et hodst ha ta reac -cessible,m otiva ti ng,a n dc a pa bleofp r oducing significa ntd at aa n dlikelytopr odu cefe ed b ack. Throughstrategiesdescribedasexa m ples,Ayres

show s b ot ht h ec o m p lexitya n dfe a si bili ty of

constr u ctin g a n d c o n d uc ti ng a n e valuation pr ocessa n dt hu soffersi mp orta ntresourc esfor evalu ati nge d uc a tion ali nt erventions.

Fr o m a si m il ar a n d c o m p le m e n t ar y p e r-spective,Agglet on(1995)disc usse st h eevalua -tio nofhealthed ucatio nprogra m sa n dattempts t odiffere n tiatebet wee nm o nit ori nga n deval u-a tion ,b a se donWH Od efi ni tio n sc h a racteri z-in gt h e masc o m ple m e n t a r ya ctio n s.Planning t heseac tio ns,int ur n,involvesth ed efin itio nof

t h e m e st ob ei n ves t iga t e d(e.g.,c og ni tivea n d behavioralas p ectsa n da ttit u d es),aswellasth e i n dic a torsa n dm e t hod ologic alstra tegie st ob e u se d.Thisdefi nitionisbas edo nth ep roposal’s objectives,resources,a n dp racticability.Duet o t hisa r ea’sdiv e rsit ya n dm a g nit u d e,Aggl e t o n hig hligh ts t h e li m it s a n d a d e q u a cy of t h ree c o m m o n evalu a tio ns t r a t egie s:t h ec o m p a r a -tiv ea p p r oa c h,t h e a p p ro a c ho nev a l u a tio nof

objectives, a n d t h e i n t e r p r etative a p p r oach (Aggle t o n,1995:198-204),sugges tingage n eral orienta tionfort heq ue stio ns.

Metho dology for ev

a

_lu

a

_{t ion}

o f Z

I

G

_-

ZA

I

D

S

Consideringt hee du ca tion alma terial’sm et hod-ologicalpossibilities,t heprese ntstu dyatte m pt-e dt oevalu a t et heZIG-ZAIDS_{g a m e’si m p a ct ,}

e st a bli s h i ng a s a go a lt h e a n a lysi s ofit s u se a n deffec tiveness,a saresourc eform o tivation, lear ni ng,a n d p reventivea n dn o n -disc rimina -tor yb e h a vio rs.W_{ees t a b li s he d c o m p le m e n} -tar yresearc hm e t h o ds,pla n n e dbyt h ea u t h ors a n d c o n d u c t e d byTorre s (19 95 ),w h e r e t h e r e sear c h e r w a sn o ti nvolve di nt h e p revious phase,cr e a t i n gt hega m e.T h es t age sw er e a s

follows:

1 )LEAS_{/ FIOCRUZfilea n alysis,o rganized}

profession,tele p hon e,an da d dress,a n dinclu d-e dq u estio nss ucha s:

• W_{herew ast h ega m e pl aye d}?_{(e.g.in s tit u}

-tio n,c o m m u nity,b usi ness,sc h o ol...) • W_{h a twa st h eagegr o upoft heplayers}?

• Wh a tw ast h egr oup’slevelofi nfo r mation a bo utAIDS?_{H owwa sth em a terialreceived}?

• W_{ast h ega m epr es e n te dwit h inap r ogram} ofAIDS_{p reve n tio nors e}x _{e d u ca tio n}?W_{erea ny} a ctivitie sd evelo p edba se do nt h em ate rial?

• Didt h ega m ere a c hitso bjec tivesa sa ne d-u c a tio n alt o ol?_{If ne c e ss ar y,p le a s ea d dyour}

suggestions.

2)O pin io nsfr o mt h ei n t e rvi ewsa n dq u es -tionnair e sfill e do u tbyg a m eus e r s,k n ow na s pr ocessa n alysis.Th ei nt e rviewsdo newit ht h e ga m eu se rsi nclu d edt h efollowi ngq u estio n s: • Na m e ofi n s tit ut io n wh e re t h e ga m e w as played;

• Wh atw asth eagegro u poft heplaye rs?

• W_{h a tw ast h eplayers’levelofinfor mation} a bo utAIDS?

• Howwast hem a t erialreceive d?

• W_{a st h ega m ep re se n t e dwit hin apr ogram} o nAIDS_{p reve n tio norse}x _{e du ca tio n}?

• Area nyo t h e ra ctivitie sa p plie dwit hi nt his progra m?W_{h a tareth ey}?

• Asa ne du ca tor,di dyo ufeelpreparedtous e t hem at erialorwa sitne cessa ryt oco n sultot h-e rs o urc es t o b e t t e r u n d e r st a n d it?_{Aft e rt h e}

materialwasu se d,wereo t h eractivitiesc a rried o u tt oa ss esst h ea s si m ila tio n oft h einfor ma -t io nb yt h e p la ye rs?_{Di dt h ega m ea c hi eveit s}

objectivesasa ne d u ca tio nalto ol?

Th equ e stion n aire swer ese n tbym ailto42 sc h oolsa n doth e rin stit utio nsalo ngwit hale t-ter.T hele t t e rexp la in e dt h eo b j e ctive soft h e

evalu atio np r ocess,a sfollows:

“We areco n d ucti ng a n ev al u a t io n o n t he i m p act of t h e e d ucat io n al ga m e ZIG- ZAIDS hereatt he Enviro n m e n t ala n dHealt h Educ a-ti o nL aboratoryoft heOsw al d oCr u zFound a-tion. T hega m ew as d evel oped b yresearchers fro m t h is i nst it u t io n w it h in t h eed ucatio n al co m p o ne n tp rogra moft h eI nsti t u t io n alAIDS program/FIOCRUZ, w h ichissu p port edbyt h e D i visi on o nSex u ally Tra nsm it ted Diseasesof t heBraz ilianMinistryofHealth. T hep urposeof t h ega m eistofocuso nt heAIDSissuetoget her w it h differe n tgro u psfro m gov er n m e n t alan d nongover n m e n t alorga n i z atio ns, privateco m -panies, an dsch ools, wit haviewtowardsprovi d-i ngbasici n for m atio nont hediseasetoabroad public, especia llychildre nan dadolescents.

Toh el pach ieveo urob jecti ves, weareco n -t acti ngprofessio nalsa ndinstit u tionscurrently develo p i ngst u d ieson preventiveed uca ti o ni n HIV/_Aids.Know ingthatyouarein v olvedi nthis

field, w econsideryou rcolla borationt obeofthe ut m osti m porta ncefort hesuccesso fourstu dy.

Asast art i ngp oi n t , w ewo ul dli ket ok now w het heryouh aveaccesstot hega m eoruseiti n an yspecificwork?Ifso, wewo uldaskyoutoan -sw ert h eq uesti on n airebelow an dre t ur nit t o theZIG_{- ZAIDSprojecta}ssoo naspossible.

1)Ho w d idy o ureceiv et h ega m e:through a ni nstit ut io norfro mso m eot herso urce?How m an ysetsdidyoureceive?

2)Wast hem aterialdistrib utedtoschoolsor ot herinstit utionst hatworkwit hAIDS?

3)Ist hereafollow - upsyste mfort heprojects t h at are bei ng carried o u t by t hei nst i t u tio ns t h atreceivedt hem aterial?

4)Ist hereso m erecordofh owt hega meis be-i ngapplied, tow h a tagegroup, tow hatscholas -ticlevela n dwit hw ha tlevelofpriork n owledge abou tAIDS?

T ha n k i ngy oui na dva nceforyo urcoo pera-tion,(...)”

3)O bs e rva tio nofZIG-ZAIDS_{’u sebyp re}

-a d ole sc e nt sa n da d olesc e n ts,ch a racterize da s im p a cta nalysis. Effor tswerem a d etoc o m bin e quantitative eva lu a tio n (s t a ti s tic al a n alysi s) a n d q u a lit at iv e a n alys is,i.e., a n alysi s of t h e opinions’c o n t e nt,i n t e r views,dire cto b s e rva -tio n,a n dp h otogra p hicd ocu m e nt a tio n.W_e al-s oa t t e m p t e dt oa c hievea next e n siveregional

sa m pli nga n ddiversityoft hes tu dyp op ulatio n, a t t e m p t i n g t o i n cl u d e s a m pl e s fr o m a wid e are aofBr a zila n dfr o m d iffe re n ts it u a ti on si n t h ega m e’s u s e.Th eresearc h wa sc o n d u c t e d wit h i nadive r sifi e du nive rs e ofpr ofessionals a n dinstit u tion sinclu dingp ublicorganizations, civila n d p r ivate,n a ti o n a la n di n t e r national, beyo n dt h efield sofe d u c atio na n dh e al th.W_e t h u sat t e m p t e dt over ifyt h ei n stit u ti o n a la n d profe ssio n ald e m a n dspertine n ttoreq u es tsfor t hega m esu b mit te dt oFIOCRUZ.

R

e

s

u l t

s

S_{i tu}a_{ti on}a_l a_na_lys_is_{: t he g}a_me’sacc_{ep t}a_{b ilit y}

Th efir stacce p ta bilityt estrefe rstot h em arket re a ct ioni tselfo nt h eo cc a sio nofth efi rs te di -tio ninJ_{anuar y1991,inw h ich5,000s e t swere} rele ase d.Alt houghpa r toft hiseditio nw asp ur -c h ase dbyi nstit u tio n sa n dc o m pa n ies,liket h e Na tio na lofficeoft h eS_ESC(Serviç oSociald o Comércio)(1, 000se t s ),t hep u blis h er(Editor a

C_ad. S_aúde Púb lic_a, Ri ode Janeiro, 15(Sup. 2):107-119, 1999 storesr eje ct edt hega m e,a n dt hisreceive dex

-tensivem e diac overage.Th issugges tst h a tt h e p ublicwa sno tre allypr eparedforata blega m e d e a li n gwi t hAIDS_{.Therefore,aft e ra n agree}

-m e n twi t ht h ea u t h o rs,t he m a n ufa ct u r e rleft t h e c o n d o m o u t oft h e s u b s e q u e n t e d iti o n s, a n ditsu sewason lyas ugge stio ninth em a n u -al,t obep u rc h as e datt h euser’sdiscre tion .The p u bli s h e rb ega nu s i ngadi str i b u tio ns tr ategy e m p h a siz in g gover n m e n t al a n d n o n gover n -m e n t ale d u c a tio na n dh e al t hi n s tit u ti o n sa n d c o m p a nie s p ro m o ti n g p reve n ti o n p r ograms wi t ht h ei rw o rkers.As ar e s ul t,t h e p u bli s h er s oldga m e st op riva t eb u si n es s e sa n dvarious

S_{ecretari e s of Ed u c a t io n a n d H e al t h a r ound}

t h e c o u n t r y; t h e Na tio n al ST D /Ai d s Control Progr a mp u rc h a se d100,000se t st odistribute t op u blicsc h o olsa n dn o ngover n m e nt a lorga -nizations.

Th eacce pta bilitywa salsoevaluatedthrough questionnaires r etur n e d fr o m 1991 t o 1994, t h atha db e e na t t ac h e dt ot h es e t sd on a te dby th eOswaldoCruzFo u n datio ntovariousgroups a n di n stit u ti o n s ( sc h o ols, he alt h p romoters, parents,c om p a nies,co urses,co m m unities,and o t h e rs)fr o mBr a zila n da br oa d .Ta ble1s h ows t h eit e m sa nalyze dina20- q u e stio n n aires a m -ple,i n clu di ngt h en a m eoft h ei ns tit utio nt h a t u s e dt hega m e,o pi n io n so nZIG-ZAI DS_{a sa n}

e d u ca tio na lr esource,t a rg e tp u blic ,ac tivi tie s develop e d,o t h e red u c a tio n alresources,pla c e use d,a n dge n e ralo bs e rv ations.Am o ngt h e20 i nstit u tio nst h a ta n swere dt heq u estio n n air es, 10 were fr o m Rio d e Janeir o, fo u r fr o m S_{ã o}

Paulo,a n do n ee ac hfro mPer nambuco,Minas Gerais,MatoGrossodoS_{ul,RioGra n d edo}S_ul, Ethiopia,a n dGer many.Thein stit u tio nsinclu d-edprimarya n ds eco n d arysc hools,h e althclin -ics, NGOs, b o ar di n g i n st it u ti o n sfor mi n or s, a n dsociala n de d u c atio n alresearchi ns tit u te s. Accordingt othedata,t hega m ewasus edi n v ari o u s si t u a t io n s:cla ss ro o m s ( p rimar ya n d secondary),p arents’meetings,wo m e n’sgroups, voc atio nalcou rses,daycarece nt ers,c o m m u ni-tyh e alt hw orkers’s u pe rvisio n,c o m p a nies’e d -uc a tio n al p rograms,c o u r s es for e d u c a ti on a l counselors,a n dm e e ti n gswit hp sychologists, s ocialwo rkers,a n do t h erh e alt hp rofessionals a n de d u c at ors.Th ei nfor m a tio nhighligh t st h e positivere a ctio nt ot h em a t e riala n dit seffic a-cya sa ne d u ca tio n alt o ol.I nge n e r alt h ega m e wa sc on sid ere dagood motivatingfact or,c a p a-bleofge n e r a tin gi n t e re sta n ds ti m ul ati n gd e -b a t es a n dle a r n in ga b ou t s u c h c o n t r oversial t h e m es a s s exu a lit y a n d AIDS. Th e p o si tive

eval ua tioniscer tified byt h equ o tesb elow: “Exce lle n tasa n ed uca ti o n a lresource. I n -for msa n dsti m ulatesreason i ngabo utprevious

knowledge”(STDsProgra m s–Do u ra d os / MS– 1995).

“G_reat!_Discussi ngAIDS,sex, a n ddr ugs be-ca m en icea n de ducatio nal”(Socied a deDiade -m e ns edePro te çã oa oMe nor–1995).

“Af terZIG_{- Z AIDS,}childrenwrotelet tersto p eoplew it hHIV(...)Itbeca m ep artofeveryday l ife i n t h e classroom, a n d besi d es t eachi ng a bo u tAIDS, it red uced discri m i n at i o n (CIE P MestreAn dr é,Riod eJ_{aneiro–1995).}

Thepossibilityofdisc ussingsexualityisp

re-se nte dinso m ereportsashavi ngb ee nsp a rked byZIG-ZAIDS_{withint h egroup.Th ega m ew as}

u sedbypare n tsa n dtea che rsw hooft e nh a dn ot know n h owt o co p ewit h t h is s u bje c t a m o n g childre na n dad olesc e nts,a sst a te dbelow:

“T hega m em akesitpos siblet odiscussAIDS naturallyan dw it h outprejudice. AIDSisadis -ease t h at i n volv es m a n y is su es t h a t are still t abooan dareoften notdiscussedbeca useof dif-f icu ltiesa m o ngt each ers, pare n tsa n di nst i t u -tions. T hei n it ia ti veofprod uci ngthega m ew as certain lyverycreative, afacilit ati ngfactor, and agrea tsocialcontrib ution.(Mu nicip alSecretary

for S_{oc ial Pr o m o ti o n, Nova Friburgo,Rio d e}

J_{aneir o)}

Accordin gt o50%oft h e20q ue stio n n aires, ZIG-ZAIDS_{w as u s e d t oge t h e rwit h ot h er re}

-sources,i nsex ed uc atio n p rogra m swhic hals o in clu d edvi de os,lect ures,d eb at es,leaflet s,a n d infor mativep a m p hle ts.Oneoft h ep oi n tse m -phasize di nt hesa m plewa st hein clu sionofs o-c ialiss u esint h ega m e,e.g.,sy m p a t hyfo ra n d discr i mi n a tio n ag ai n st c h ild r e n wit h AI DS_,

w hic hh a sm otiva te dd e b a t ea m o ngt h eyouth w h oh aveu se dt h em ate rial.

S_{o m ec riticis mwasaim e da tt h erepetition}

of q ue stio n s, m ai nly by t h e ki ds wit h m o re knowle dgea bo u tAIDS_{.Th elackofaprize(th e}

co n do m)forallplayers,oratleas to neforea c h classr o o m , t h e n e e dfo r m o re diffic u lt q u e s-ti o n sfo rold e rst u d e n t s(8 t hgr a d e rsa n dh ig h s c h o ol).S_{o m es u gg e s ti o n so nt h ec a rds’c o n}

-t e n-twereusefulforth ese c o n de ditio n,a swell a si n clu sio noft h e m esi nt h ewildc a rd sse t,i n or d e rt oalw aysi n clu d eu p d at e di nfo r mation i nea chn ewe ditio n.Bo thi nte r na tio n alinstit u-tions,Mesga n a nNegaAd disAb a ba(Ethiopia) a n d a n i n st it u tfr o m Be rli n,Ger many, h ig h -light edt h equ alityoft hega m e,tellingu sab ou t t h e la c kofs u c h m a t e ria lsi nt h e ir c o u n t ries.

S_{i n c et h ec a rd sh a dn otb e e nt r a n sla t e d,t h ey}

Table 1

Examples of answers_received on use of the game. Situati onal evaluation.

Name o f ZZ asan educat ional Ta r ge t pu blic Act ivit ies Ot her educat ional Place used O b s e rv a t i o n s

I n s t i t u t i o n re s o u rc e d e v e l o p e d re s o u rc e s

Municipal Council Rea_ches its objectives. _People aged Prevention work Semina_rs, pla_ca_rds, Community

Três_Pontas, MG While theya_re playing 1 2 - 5 0 during Ca_rnaval pamphlets. A TV institutions,

people debate the week. _Tables were was installed to businesses,

answers to the game set up in the squa_re show videos on and scho ols

with the other w h e re the general A ID S

p a_rticipants publiccoul d

p a_rticipate in the

game. Discussion

o f ZZ questi onsand

a n sw e rs

C_EL–Lagoa _The game is goo d, Students fro m Sex education Raising questions Sc h o o l s _Inadequate when

Educational especially for 6th and 6th-8th grades, p ro g ram that rea_ched the applied to the 8th

C e n t e r, RJ 7th grade students aged 12-14 public in a general grade, considered

aged 13. We felt that w a_y too immature, and

it lacked more students did not take

co n t roversial questions advantage of the

suitable for 8th grade game. There should

students be more ca_rds for

the 8th and 2nd

grades, allo wing

g reater flexibility

acco rding to the

level o f knowledge

of the working gro u p

São Vicente State The game generates Students from Magazinesand High s_chool One of the negative

High Scho ol 1st curiosityabout o ther 5th-8th grades newspapers with points was the lack

and 2nd grades. topics_related t o AIDS and high scho ol newsand up dates of incentive for the

Irati, RJ and sexuality discussed in g roups, prizes (...)In general it was s e m i n a_rs consisting of only

useful and the students t h ree cond oms

l e a_rned by playing.

S e m p re _Viva _The youngsters _Young peo ple Use of the game Program hasas its S e m p re _Viva One o f the girls in

Program, RJ co n si d e red the game Aged 17-19, was pa_rt of objectivesasystematic Pro g ram the group asked that

an enjoyable girls who live constant process p ro ject for DS_T/AIDS the game be ta_ken

experience on the stre e t of informati on p revention and into the streets to

transferand aw a_reness of wide- allo w the rest of her

incentive to use, ranging health concern s g roup t o play. There

condo msseeking isstill no method of

the pa_rticula_r evaluation for its use

e xp ression of among street peo ple.

the group in

devel oping action t act i cs

Cyanami d Química _Immense po tential to 25-45 yea_rage The material was Semina_rs on AIDS with Co m p a n y The material was

do Brasil Ltd., RJ rea_ch the prop osed g ro u p ap plied only once orientation bycompany received with

o bjectives, including within S_IPAT p h ysi ci a n s surprise, even wi th

p a_rtnerships with (I n t e rnal Week for re s e rvat ions, but the businesses for work the Prevention of general reception in scho olsand other Accidentsat Wo rk) wasvery good. They

i n st i t u t i o n s w e re expressions of

moral outrage (based

C_ad. S_aúde Púb lic_a, Riode Janeiro, 15(Sup. 2):107-119, 1999 adequate,n e c ess a ry,a n dus efulfo rt h eo ng o

-inge d u c atio nalpr ocess.

The p rocessanalysis: the game’scon tex t a_{nd u t ili}za_{ti on}

Inord ert oc o m ple teth ei nfor m atio nob tai ne d thro u gh t h efo r ms,we s e n ta st a n d a rdle t t e r co n tai n in gaq u es ti o n n air e,fro mFebruaryt o April1995,to42sch o olsindiffere n tS_tates,i.e.,

th eo n eswhichha dreceivedt h ega m et hr ough t h e He al t h Ministry (t h e N a ti o n a l S_{TD /Aid s}

P rogr a m .A st a n d a r d q u e s ti o n n a ire wa s a lso se n tt os ever ali ns tit utio n sa n dco m pa nie s.W_e receive da nswer sfro m atotalof34ins titu tion s. Da t a a n alys is, organiz e di n a t a bl e,wit h t h e s a m ec o n t e n tsd esc r ib e di nt h ep revi o usit e m ( Ta bl e 2), reinforc e t h e e va lu a t io n s alr eady m e n tio n eda n drel ate dt ot h ega m e’seffe ctive -ne ssa safa ct orfore d u c atio n alm o tiva tio n,as a ne asy-to- u n de rs ta n dtea c hi ngtool.Alt ho ugh th ega m eh asb ee nuse dbyvario u sgroups,t h e majoritywerea m o ngad ole sc e nt sfr o mt he5th thr o ugh8t hgr ades,wit hagesr a ngi n gfro m10 to16years.S_{o m eexa m ple sofrepor t s}:

“ZIG_-ZAIDSisw h a teveryst u de n tneedsto

u n dersta n d w h a t isi m agi ned n ot t obe near him. Ify o ugiveabookorlect ure, 90%oft h e m

w ill re m ai n sile n t” (Ca rla Jard i m , r ur al a rea te ac h eri n Bagé,RioGra n d edoS_ul,1995).

“Thereh asbee ngreate n t h usi asmovert h e ga m ea m o ngt hek ids. T hecreativea pproachto

AIDSw ase m p hasi zedan dt heop port u nityt h at

thega m eofferstodiscussa m pleq uestions,such

associalaspects, prejudice, a n dsol id arity”(An -t ô nioTeix eir a, Director,La b o rRel a ti o n s D e -part m e nt, Br azilianPo st alCompany,1995).

Thisa n alysisalsoco nsidere dtheZIG-ZAIDS

evalu atio na d d ress edtot h eNa tio nalS_TD/Aids

ControlProgra m .AsofMarc h,1995,10m o n t hs aft ert hep u rchase,25%oft h es ets(25,000)ha d b ee ndist rib u t e d.Oft h e27le t ter ss e n tbyTo r-rest ot h eS_{tat eh e alt ha n de d u c a tio n alde p ar t}

-m e nt st hatreceivedt hem ate rial,only5replied. Am o n gt h es e,4h a dreceive dal ar ge rn u m b er ofs et sa n ddistrib u te dth e m tosch o olst oi nte-gr a t e t h e m i n t o t h e p r eve n t i o n p r ogr a m . I n or d e rt oc o m ple t e t hi sa n a lysi s,Torr e si n t e r -viewe dt h ep eo plere s p o nsiblefordis tributing th e ma te rial.

Consideri ngt h e54in stit u tio n sw hic hrep -res e ntt h et otaln u m b erofq u es tio n nairess e n t t oLEAS_{(199 1t o1994)a n dt oTorr e si n19 95,}

84.2%st atet hattheobjectivesofth ega mehave be e n“fullyreached”;3.70%s ay“satisfactorily”, a n d1.7%“r e a s o n a b lywell”.No b o d yn o t e d“a little”,a n d9.3%faile dt oa nswert hisq u estio n.

Impac_t a_na_lys_is_{: o b}s_erva_{t ion}s

on us_{e o f the g}a_me

Thisa nalysisisb a se dondirec tobse rvatio nsof

t hega m em a tche swit hkidsfr om11to17years ofagefro mtwop riva tesch o olsa n dth eInstit u-t od eAçã oCultural(Cultur alActio nInstitute), byw hic hweo bs e rve dt ha ts t u d e nt sc o n s t r uct n e wc og n itiveel e m e n t sbypla yi n gt h eg a m e. Fille dwit hexci te m e n t ,t h eg a m e’sc o n t e n tis

gr a s p e de a sily,b esi d e si nit ia tin gd e b a t e sa n d expl a n a ti on so nt h e t o pi c.O n et e ac h e rc o m

-m e nt ed,“Wen oticedth atevent hech ildrenw ho

kne wt hem aterialgoti n volve di nt heactivity” (1995).Co m p e titio ns ti m ul at e sle a r ni n gwhile p layi n g,m aki ngitr ig h tt owi na n dp ayi nga t -t e n -tio n t ot h erigh ta n swe rssoa sn ott om ake m ist akesagai n.However,th equ es tion’srepet i-tio nasac on se q u e nc eoft h ega m e’sdy n a mic s wa scriticize dbyt h em oreinfo r m e dstudents.

S_{o m eyo u ngp eople’sop inio ns}:

“ZIG_-ZAIDSisperfect. Ifitwereanybetter, it

wouldbeworse”(1995).

“Iw ou l d l iketok n o w m oret hi ngsn oti n

-for m edbyt hega m e”(1995).

”Ih avelear nedtonotbeprej udicedtowards

p eo plew it hHIV. T h eyd eser veal lou rcarea n d

attention”(1995).

“IfI w erey o u, Iw o u l d m a n u fact urem ore

ga m esto distrib u t e t h e m all ov ert h e w orld” (1995).

Torr e s a ls o organize d t h e c o m m e n ts by s o m ep r ofes si on a lsi nvolv e din t het e st i n gof

ZIG-ZAI DS_{.I nge n e ra l,t h ega m ew a sc o n si d}

-er edate a chingresourceca p ableofa p p roach -i n gac o n t r over sia lt h e m e i na ne n te rtaining a n defficie n tw ay.Accord ingt os ugges tio ns,it s u ses h o u ldb es tr e n gt h e n e dbye d u c at o r s’a c-tio nsi nt hese n seofd elvingm ored e e plya n d / ora d a p ti n gt h eco n t e n t st odiffe r e n trealities. Th efewc riticis m stoward sc er tainco nte nt san d t h e m a t e r ial’sdy n a m icswerealld o cu m e n t e d byt h ea ut h o rsa n dt ur n e din t oi m p rovements in t h ega m e,i nclu di ngt h ep r o p osa lfora nex

-p a n d e dve rsio nonCD-ROM,c o n tainin g6 lev-e lsofd iffic u lty,m a ki n gitp os si bl et opr ovide c h oic esbya gea n dp r evi o u sk nowledge.This allowsfo rt h ea c q uisi ti o nofs cie n tifi c a llya d -va n c e da n dc o m pl ex kn owle dg ea cc o r di n gt o t h eus e r’sc u riositya n dcog nitivec a pa city.

As e c o n dexp e r ie n c ew a srepor t e d byt h e

Par a n áS_{t a t eDepar t m e n t sofEd u c a t i o n a n d}

H e a lt h ,w h i chu s e dt h ega m ei n t eg ra t e din t o a preve n ti o n p r ogr a m d e velo p e d i n s everal s c h o olsa n d he alt hc e n t e r sa r o u n dt h eS_tate.

Table 2

Examples of answers_received from 34 institutions. Processanalysis.

Name o f ZZ asan educat ional Ta r ge t pu blic Act ivit ies Ot her educat ional Place o f O b s e rv a t i o n s

I n s t i t u t i o n re s o u rc e d e v e l o p e d re s o u rc e s a p p l i ca t i o n

Mesganan Nega Allows_young people General public Leaflets, posters, films, D i fficulties were AIDSControl to relax while in the country and dramatizations e n co u n t e red in using

Pro gram, Addis transmitting knowled ge the material because

Ababa, Ethiopia about HIV/Ai ds. of language

Recommendable for p ro blems: when

teaching young people letter wasanswered

and their pa_re n t s the game was being

translated. The i m p ression is general based on the figures. T h e re is no material

available on AIDS

p resented in the

f o rm of a game in

thiscountry

C_IEP– Mestre Treatsacontroversial El e m e n t a_ry The game was used Studentsand After using ZIG_-ZAIDS

A n d re, Padre issue in an students, aged asa toy: a form of residents of he chil dren decided

M iguel, RJ e n t e rtaining way 8 - 1 3 competition. Later the Vila_Vintém to write letters to

it was used as shanty town people with HIV.

a lea_rning tool

requested by

st u d e n t s

Federal Technical Valid. M otivates the Team of Pa_rents’ meeting. Videosand semina_rs _Technical We would only

College of adolescent toknow teachers, health Meeting with with doctors. Debates College and question the answer

P e rnambuco, PE the dangerand p rofessionals, specialists and analyses wi th AIDS Clinical Hospital to the question on

understand the AIDS social workers, ineducational study gro u p hemo philiacs, which i ss u e psychologist, orientat ion. Debate defines them as

p a_rents, and and analysis with people who have

students AIDSstudy gro u p d i fficulty in forming

sca_rs. Shouldn’t it be “ d i fficulty in blood

cl otting ”?

Municipal Council A p p roaches AIDS in Students, Activities to pre v e n t Announcements, Co m m u n i t y, In the talks_I try to

N ovo Friburgo, RJ a natural wa_y, without tea_chersand AIDSand drug use _Videos, pamphlets, s_cho ols of the get a_cross the need

p re j u d i c e . the community – talks for teachers, games, and books that public, state to inform peo ple,

in general studentsand dis_cusssex education and private while showing the

Pa_rents. Wa_rnings n e t w o rks _re so u rcesavailable,

to the community. to facilitate the work

of people who come

f o rw a_rd offering to

be multi pliers of

i n f o rmation on AIDS p revention

Health Center, Cl e a_r, objective Studentsaged Integral health ca_re Weekly meetings to Center for

Juquiá, S_P questions. Stimulates 1 3 - 1 5 f or the adoles_cent dis_cuss themes of living Together

i n t e rest in lea_rning p roject. The game public intere st . with the Ill.

t h rough pla_y. was presented on Public building.

a day when AIDS was the theme.

Dourados _Excellent asan Members of I n f o rmation leaflets, S_choolsand

D S_T/ A ID S educational re so u rce. the team and videotapes, talks to evening classes.

I n f o rmsand stimulates students o f the ad o l e sc e n t s .

reasoning about 2nd grade and

C_ad. S_aúde Púb lic_a, Riode Janeiro, 15(Sup. 2):107-119, 1999 primarya n ds eco n d ar ys c h oolsu n d ert h e

ori-e n t atio nof223s u per vis orstr ai ne dt od evelop preventive ac tivit ie swi t h yo u n g p e o pl e a n d th eirte ach ers.Thereportdescrib esthre eexpe

-rie n cesa tdiffere n tlevel s:o newit h7t ha n d8th gr a d es t u d e n t s,a n o t h e rwit h5 t ht o8t hgrade students,a n dat hirdwit hfirs t -ye a rse co n d ary sc ho olst u d e n ts.O b se r va ti on sbys u p e rvisors a n d t e a c h e rs high lig h t t h e g a m e’s a b ilit yt o st i m u l at et h el e ar ni n gp ro c es sin ahig hlye n -tert ai ni n gw ay.S_{o m ei m p ort a n tc o m m e nt s}:

“T h ega m eprovi desv a lu a blei n for m a tio n,

w hichisp assedontot hest u den tsi nalighta n d naturalfor m .”

“T h esa m eq uest io nisask edse veralt i m es,

e m p h asi zi ngthees sen tialpoin tsont hetop icof

AIDS.”

“I w asi m presse dbyt h est u d e n ts’enthusi

-asm a n dt heir de dicat io ni n read i ng a n d a n -sweri ngt heq uestions, tot heexte ntofm e m oriz

-i ngt h erigh ta nswers. Th ei n teresti nw i n n i ng t h ep rize(aco n d o m )w as m ostn o t ablei n5t h gra dest u dents, w h ow oul dfin ditm oredifficult

toob tai nprop hylacticsu n d ernor m alcircum

-stances.”

“I’mgoi ngt oorder m oresets, a t t hei nsis

-te nceofm yst u de n ts. T hisisaverypositiveway

tot al kab o u taveryd a u n ti ngsu b ject. Im yself

ha dacousinw hodiedasaco nsequenceofAIDS

inJu ly1995...”

S_{o m et e a c he rsc o m m e n t e dt h a tins pit eof}

th efa ctt h a tre p etitio nofth ecard shel psm e m -orizet h ec orre cta nswers,“t heydid n’tli ket his

processo frepetition, preferri ngt om oveo nt o new q uest io ns”.Sever alt e ac h erss ai dt h a tt h e st u d e n tsw a n te dm orequ estio n st oe n ric ht h e ga m ea n dgiveit m orevaria tio n,i n cr e asi ngits inter esta n dc a t er i n gt odiffe r e ntl evelsofc u -riosity.Alt ho ught heold er,m orea dva n ce ds tu -d e n tsagre e dt h att h eg a m ewa sa nin t e resting wayofde alingwit ht hem at te r,facilitatin gdia -logu eo nsexu alityw hic ht h eyfeltiss tills o m e

-w h atrepr e ss e deve n t o d ay,t h eyfo u n d s o m e q u e s tio n sto oe a syforst u d e n tsi nt hese c o n d ye a r ofhig hs c h o ol.Th isi sn a t u r a l,si n c et h e ga m e was cr e a t e d for pr e - a d ole sc e n ts (9 -12 ye ar sold ).However,c o m m e n tsbyt h es eold e r s t u d e n tsill u st r at et h en e e dt oc re a teversions wit hi ncre asi nglevelsofco m plexitya n dde p th

ofkn owledge.

D i

s

c

u

s

s

i o n

Bas e do nt h er esult sc olle c t eda te a chdifferent st age of evalu a t io n , we c on cl u d e d t h a t t h e population’si nfor m a tio nlevelism or erelevant t ot hega m e’si m p a c tt h a nage.An ot h e ra s p ec t

r ela t e st ot hed iv e rsityof ZIG-ZAIDS_{’u se.The}

ga m e w a sa p p li e dt o h e a lt ha n d e d u c a t io n al pr ofe ssio n alt ra i ni n g,i na c tivit ie swit hs t reet girls,in m u nici p aleve n tslikeon ei nTrêsPo n-t as(Mi n asGeraisS_{tate),wh ereitwasplaye don}

t a b lesi nt h et owns q u a red ur i ngCar nival,b e -s i d e-s o t h e r a c tivities i nsc h o ols, c o m p a nie s, a n dc o m m u nit ies.Att h e h e a lt hc e n t e rin Mi-g u e lPereir a (Ri o d eJ_{aneir o}S_{t a t e), t h ega m e}

boar dwast u r ne di nt oac a n va s;att h eColégio Bandeira n te sint h ecityofSã oPaulot h ega m e wasr eprod u c edo noverh ea dtr anspare nciess o t h a t all t h est u d e n tsc o u ldt a kep ar ti ns o m e observations.

Finally,aft ermo n t hsofc o nt actwit hprofe s-s io n als-sa n ds t u d e n t st h a th aveu s e dt h ega m e ins evera lpa rt soft h eco u n t r y,Torre sremarks t ha t“ZIG_-ZAIDSisanin telligen tan da ppropr i-at ealter nat ive, beca useitprov idesinfor m ation

a bo u tAI DSi nap l ay f u l,creative, a n di n n

ova-tiv ew ay. Si ncet h ega m e isf u nto pla y, i t de-cre asesan yprob ablee m b arras sm e n t(...) and

allowsforin - dept hq uestio nsco ncern i ngsex

u-ality”( Torres,1995:51).Inp ractice,r epetition oft heca rdsw asco nside re dn egative;alt h oug h t h egoalwastohel pm e m orizet heinfor mation, t h e pl aye rsge n e r allyt e n d e d t og e tt ire da n d justgoa he ad.Nevertheless,t h ega m ewa sco n-sidere d a neffe c tive,i nfo r mativeresource.Its usewasassociat e dwit hco m ple m e nta rytea c h-i nga ctivities,toa da ptitsla ng uaget ot hep op u-lationwithre a di ngdifficultiesa n dt heco nt e nt exp a n d edforgro u pswit hbe tt e ri nfor mation.

Th er esu lt soft h iss t u dy,b e si d esc o m p le -m e n ti n ga n dexp a n di ngp r e vi o u sevaluations

on t h ega m e’sre ac hi ndiffe re n tc on t ext s,offer

s ugge s ti o n st os tr e n gt h e n t h ega m e’sus ea n d d a t ac a p ab leofgui di ngn ewm a t eri alp rodu c-tio ni nt hisfield,s uc hast heon goin gCD-ROM. I no t he rwo rds,wes e e t h eeval ua t io np rocess a safu n d am e nt alresourc efort h ec o m pr ehe n-s io noft h eo bj e c t ive sa n dr e ac hofa ne d u c a-tio n alp ro posal.Fro mthisp rocessweca nrefo r-m ulat ea n d / orrepr od uc eou ra ctio n s.

T hisi si m p o r t a n t t o reinforce t he ga m e’s roleasafa cilita torforco nvers atio nsa bo u tsex

-u alityeit h era tschoolorath o m e.Onlyrecen t-lyh aveBra zilia nsc h oolsb egu nt opreparefor t h e c h a ll e n g e of a c hi evi ng full e d u c a ti o n i n w h ic hs exu a lit yisa p p r o a c h e dbyass ocia ti n g

o-R

e f e re n

c

e

s

AGGL ETON ,P.,19 95.Monitor a m e n toeav a li a ç ã od e e d u c a ç ã oe ms a úd eep ro m oç ã od asa ú d evolta -d o sp a r a oH IV/Ai d s.I n:AIDSPesq u isaSociale Ed ucaçã o(D.Czere s nia ,E.M.Santos,R.Barbosa &S.Monteir o,org.),p p.193-206,Sã oPa ulo:Ed i-toraHu cit e c /Riod eJaneiro: Abrasco.

AYRES,J.R.,1 996.Co m oAva li a ru m aInter venção? Secretariad oEstad od aEd u c açã o–Fu n d a çã op a -raoDesenvolvim e nt od aEducação.( m im eo.)

BAKH TI N,M.,1985.Est éticadel aCre ácio nVerbal. Bu e no s Air es:SigloVe in ti u no Arge n ti naEditores.

BOLTON,R.,1992. AIDSa n dp romiscuity:Mu d dlesin t h em o d elsof H IVp r evention.M ed ica lA nthro -pology,14:145-223.

CARRARA,S.&M ORAES,C.,1 986.U mm a ld e fo lh e -ti m.CadernodoIM S/UERJ,1:79 -94.

DAN IEL,H.&_PARKER,R., 1991.AIDS, aTerceiraEpi -demia.Sã oPaulo:Iglu.

FREIRE,P.,1979.Conscientização, Teori aePráticad a Libertação.Sã oPa ulo:CortezeMoraes.

lesc e ntsm ee tt he irp ar t ner sa n dre h ea rset h eir lovelives.Despit et h eor eticaladva n ce si n psy-ch ologya n dpe d agogy,e d u ca tio n alp ra cticeis s tillc h ar acteriz e d bye m p h a sis o n t ransmis -sionofco n te nt swhicha ren otalw aysu sefult o s t u de n tsi nlife.Nevertheless,i nclassroo m , be-yo n dt hefor m als u bje ct,t h e reisa no t h e rc o n-t ext h a p p e n i ng wh ic h is c ha racterize d by a

sc h e m eofrela tion sa n dh id d e nc o nflic t swit h t h eb u syt e a c h e ra n dw hic hc a nb e m ad e ex

-plicitifalt ernativesarecr eatedfort heirexp re

s-sio n ,a n dga m e slikeZIG-ZAIDS_{c o uldb eu s e} -fulint hiss e ns e.

Alt h o ug ha wa r eoft h e li m it e dkn owledge concer n i ngb e h aviorc h a n ge,w eh avehe ret h e gre a t e stc h alle n gefore d u c a ti o n ala c tivit y.As

Rose n s tock(1990)s t a t es,k nowle dgeisim p o r-t a nr-t,s o m etim e se ss e n tialforbe h aviorc h a n ge, b u t it israr e lye n o ug h. It isi n t h e u n kn own wo rld ofr e a s o n t h a tp e o pl ea re d r ive nt ob e -haveino newaya n dn oti na n ot he r,w he reo n e

fi n d sh e a lt ha n ddis e a s e,h a p pi n essa n dg rief, a n ds u cc e s sa n dfa ilu re,a m o n gst ot h e r p h e -n o m e -n a.Thus,t h ee d u ca ti o n a lp ro c es sm u s t b ei n t egr a t e dwit haffe c ti nord ert ob egin t h e necessary ch a n g es.Th e m e re a c q u isitio n of

knowle dgeisn ote n o ught oe n ge n d ert h ea tti-t ud esa n dactionsth atar eth everygo alofe d u-c a tio n ali nitiativesint h eh ealt ha r ea.

MaterialslikeZIG-ZAIDS_{a rece r tainlyfa}

cil-itat orsoft hispr ocess,w hic hrequir ese na bling

of e d u ca t o rst o a c hie ve it sg o a ls,al o ngwi t h orie nt a tio na n devalu ationofitseffe ctiveness, compari ngth es t r ategies’vari a tio n sa n dc o n -textsoft h ec u r re ntwork.Sch all(1996)already

r epor t e d t h a t he alt h - rel a t e d kn owle d ge ex

-pre ss e s t h a t c hild r e n p la c e valu e o n t h e m -selve sa sh e alt hya n dreve alst h em e a n i nga n d valu est h eya scrib et ot hisfu n d a m e nt ala s p ect oft h eirlives.Thus,ita ls orev e alse a c hc h ild’s identity,his / h erp erceptions,exp e riences,m

o-tivations,a n da c t io n sexp r e ssi n ga nim ageof

on e s elf, m a ki ngi t p os si ble fo rt h e m t owork beyo n dp hy sic ala n dc ognitiveas pe c ts.

It is b el ieve dt h a t in rela ti o nt oS_{T D /Ai d s}

a n dd r ugs,iti s n ec es s a r yt og ob e yo n d b o t h tr adi ti o n a l p ra c t ic es ofk n owle dge t r ansmi s-siona n daclim a teofth rea tstoco nsi deralo ng-ter m i n t e rve n ti o n b eg u n i n p re -sc h oo l.This wo u ld b e c a p a b le of st re n g t h e ni ng c hild ren a n da d ole sce n t si no rd e rfo rt h e mt on o to nly b e tt eru n der st a n dt h e ms elvesb uttoalsop rac -tic e c o m m u ni ty ac tivit ie s t h at s ti m ul a t e re -s p e ct a n d re s p o n s ibili tyfor t h e m se lve s a n d others.Thisisn e ce s s ar yforch il dr e nfro m a n e a rlya get on o ta cc o m m o d a t e t h e m s elves t o un bala nc e da n du nfairsocialsit u atio ns,t oe n -ab leth e mt omakech oic es,wit ho u tfeelin ge m -barr a ss e dbyt h egr oup,a n dt oa c hi eveb e t t e r h u m a nr ela tio n sa n db e t t erc o m m u n ic a ti o n s a n de m p a t hyt h ro u gha n e d uc a tio n a lp rocess inwhic hfa m ilie sa n dsch o olsin t er act.

A

c

k n o w l e d g e m e n t