Juan José Meré is demonstrating how practical, common sense AIDS/HIV prevention measures can begin to address a much wider and deeper public health problem infecting Uruguay–sexual machismo.
The New Idea
Juan José Meré is using the urgency generated by a life-threatening disease, AIDS, to undertake educational activities among young people that challenge and undermine the machismo mentality that dominates Latin American sexual relations. As he succeeds, he will not only stop the HIV virus in its tracks, he will expose the root cause of the centuries-long domination of women by men, first in Uruguay and then in the wider region.
Juan José's state-of-the-art AIDS prevention techniques–including attention-grabbing posters, pamphlets, TV and radio public service announcements and highly innovative workshops and counseling services–are creative and effective. But even more significant, the content of the discussion-group-based games and role playing fundamentally challenges the macho culture that young people grow up into. Those who participate in these sessions can never again accept machismo uncritically, and many are motivated to evangelize for a "health culture" that, as Juan José puts it, "invites open discussion of sexual attitudes and behavior, and encourages people to voice their fears and beliefs in a climate of acceptance and personal responsibility."
The personal and societal costs of machismo, with its rigid sex and gender roles and its closed and covert sexual attitudes, have never been calculated, but they are astronomical. The very fact that machismo is not widely understood as a health problem, for example, is direct evidence of the gravity and nature of the problem.
No social phenomenon–be it unwanted pregnancies/abortions, untimely marriages, the subjugation of women, prostitution or the spread of sexually transmitted diseases–has highlighted the health threat of machismo better than the AIDS pandemic. A growing and serious problem in Uruguay, AIDS is transmitted sexually in 75 percent of cases. Cases are split almost evenly between homosexuals and heterosexuals, with heterosexual women being the fastest growing group. The death rate is currently 51 percent. In Uruguay, the largest affected age group is between 15 and 34 years of age, making adolescents the most urgent prevention target.
Yet given this vector, Uruguayan society is hopelessly ill-prepared to educate its young people about how to relate to each other sexually in ways that are healthy. There is little agreement what healthy sexual relationships should be for the young, with most adult Uruguayans preferring to pretend that young people do not engage in sexual intercourse before marriage.
As the virus rages through society, many Uruguayans are coming to understand the underlying nature of the problem. As Juan José notes, the wider implications of the spread of AIDS have "...shocked our most intimate feelings, values, and relationships."
Juan José's popular education and AIDS programs enlarge adolescent awareness and knowledge of AIDS and of prevention methods, casting them in the larger context of sexual attitudes and behavior. Even more important, they help Uruguayans young and old understand the terrible costs–to health and human dignity–of sexual machismo. Juan José's overall strategy, then, is to use the threat of AIDS to design and implement education prevention programs that both kill the virus and root out machismo.
Not surprisingly, given these perspectives, Juan José's programs for adolescents are multidisciplinary and very interactive. He is developing new forms of participation; for instance, using games to promote a more positive interaction among adolescents. These games include word association games, teaching games (for instance, how to use condoms and safe sexual practices) and role play games designed to encourage personal reflection on attitudes regarding sexual practices and preferences. They also relate these attitudes and behaviors to a human rights perspective that insists that all persons–and in particular women and HIV/AIDS sufferers–are entitled to equal concern and respect.
He is also training those in daily contact with adolescents, such as teachers, mentors, health workers and community leaders. Juan José and his colleagues have developed written training materials explaining how to use their novel techniques (such as group teaching and group participation) and offering guidance on how to mobilize local resources.
He stages an annual "seminar" to discuss and plan overall AIDS prevention strategies with all those participating in his programs plus a wide range of private and public agencies.
The potential of Juan José's methods is shown by the Multipliers' Network, which is composed of about 300 young people and adults, professionals as well as neighborhood volunteers, who carry out community AIDS prevention activities as part of their daily regimen. The network publishes a bi-monthly bulletin, invents new games and organizes health-promoting activities.
Juan José directs his AIDS prevention programs from his position as Coordinator of the Health Department of the Institute for Research and Development, a nonprofit organization dedicated to health and social issues. The Institute's programs are financed by national and international governmental and nongovernmental agencies, including the U.S. Council of Churches, UNICEF, Medicos Mundi and the French Embassy, as well as Uruguay's Ministry of Public Health.
From his earliest days, Juan José was a leader in group sports and play in his neighborhood. Joining the Scouts, he organized various educational, recreational and community support activities.
Juan José's commitment to social justice caused him to leave Uruguay during the repressive military dictatorship. Arriving eventually in France, he began his university studies while working in a hospital specializing in cancer. At this point his two children were born, "...to whom I intended to show that life doesn't consist of things carried in a suitcase, but in gestures and actions of solidarity, even little ones, for others." He was particularly affected by his hospital work with children and adolescents suffering with cancer: "playing a game with them was a victory of hope against time. The game was life."
When the hospital took in AIDS patients suffering from rare forms of cancer, Juan José began to knit together the threads of his life: the intuitive and empassioned educator longing to create nontraditional teaching methods; the university sociologist challenged by the cultural shock; the Uruguayan social reformer taking advantage of his exile to shape and strengthen himself for the battle with machismo to come; the untiring "...enjoyer of the intelligent vitality of little ones, whatever their language, skin color, or the ground they walk on."
He kept up his contacts with the Uruguayan community in Paris and, despite fourteen years of successful and comfortable life in France, Juan José returned to Uruguay with democracy.
Continuing his work in health as an instructor on the university's medical faculty, Juan José taught subjects related to social health and involved medical students in social issues in the cantegriles (shanty towns) of Montevideo. At the same time, and working as a volunteer, Juan José created and directed the Institute's health program, now its largest program, dealing with contemporary health issues, including women's health, mental health, health and work situations and adolescents and sexuality. Perceiving, however, the threat posed by the dramatic spread of HIV/AIDS, Juan José set to work to build a serious campaign. Now occupying him full time, Juan José hopes his work will bring Uruguay to a new understanding of its soul-destroying macho culture through its experience with AIDS.