PSI’s network member in Guatemala is the Pan American Social Marketing Organization (PASMO). Founded in 1997, PASMO Guatemala began as a regional HIV prevention program, and later expanded to address reproductive health, family planning, gender-based violence prevention, Zika prevention, and post abortion care. Guatemala is home to the PASMO regional office which supports all PASMO offices in Central America and other PSI network members in Latin American and the Caribbean.
In Guatemala, two registered entities work side-by-side to improve the health of Guatemalans – one is a social enterprise company and the other is a not-for-profit organization. The Social Enterprise addresses post abortion care, harm reduction and safe abortion advocacy within the context of the law. The not-for-profit organization implements US funded HIV, family planning and Zika programs in addition to addressing gender based violence with funding from the Swedish government.
PASMO estimates that in 2016, its products and services helped avert 50,000 DALYs, including, by health area:
- 18,000 HIV DALYs
- 32,500 FP DALYs
- 156 MNCH DALYs
PASMO’s family planning programs also provided 284,878 couple-years of protection.
PASMO takes a combination prevention approach to preventing HIV in Guatemala. For men who have sex with men (MSM), and transgender women, they promote outreach interventions focused on knowing one’s HIV status, HIV testing and counseling (HTC) services, and referrals for treatment and complementary services. PASMO also works to ensure that individuals are linked to care, and adequate support is provided along the entire HIV continuum of care.
HIV prevention efforts also include reducing stigma and discrimination towards key populations and persons living with HIV, such as the Generación Cero social movement and the creation and identification of “stigma and discrimination-free zones.”
From 2011 to 2017, PASMO Guatemala implemented the USAID PlanFam project in five departments and 30 municipalities in rural areas of the Western Highlands. The municipalities were equipped with family planning clinics and trained staff who now offer high quality services while following strict privacy and confidentiality regulations. Five local offices were established with the goal of reducing maternal mortality by increasing the use of modern contraception. The project reached 12,566 adolescents and 346 educators in targeted geographical locations, all of whom were trained on issues related to sexual and reproductive health (SRH). In addition, 102 public health providers were trained in the use and insertion of long acting, reversible contraception. The project continues as part of the Maternal and Child Survival Program (MCSP).
Gender Based Violence
According to a national survey, 24.3% of married or previously married women in Guatemala between the ages of 30 and 39 have experienced at least one violent act from their partner in the past year.
PASMO Guatemala addresses gender based violence (GBV) with aid from the Embassy of Sweden and in coordination with multiple partners, called the Ixoqib Consortium. This program provides specialized psychological, medical and legal services for victims of sexual violence and increases their access to resources in the departments of Quiché, Huehuetenango, Totonicapán and the Guatemala.
The program advocates for the inclusion of GBV and gender related issues into legal and medical legislation, as well as increased awareness of GBV at the community level. Facilitators use public events, forums and multimedia campaigns to educate community members about GBV-related issues, prevention and available services for survivors. The program trains parents, educators, health workers, adolescents, women and community leaders that focus on GBV, gender equity, and sexual and reproductive rights. Men are also trained on stress management, interpersonal communication, and conflict resolution techniques. GBV survivors develop skills in entrepreneurship and financial literacy through referrals to labor training programs provided by INTECAP and COSMOPROF, allowing them to pursue new economic opportunities.
PASMO Guatemala markets and sells condoms and lubricants, in addition to other family planning products, to help reduce HIV transmission and improve sexual health, a strategy that complements social and behavior change communication activities. PASMO Guatemala recognizes the importance of improving the availability and accessibility of condoms for those with a greater risk of HIV infection.
The condom availability and accessibility program focuses on product distribution in three distribution channels:
- Traditional, through pharmacies.
- Non-traditional, via convenience stores, supermarkets, “mom-and-pops” stores, warehouses, etc.
- High-risk, at night clubs, motels, date houses, etc. that are linked or highly associated with sex work.
PASMO Guatemala recently introduced a project to address Zika in the country. Working closely with the Ministry of Health and other partners, the project improves community engagement and quality of services involved in Zika prevention. Activities include outreach through community events, private health clinics and a mass media campaign using radio, billboards, and other forms of media. This is aimed at educating women of reproductive age about the misconceptions, signs, symptoms and prevention of Zika. Another key factor is the distribution of Zika prevention kits, which include informational materials, condoms, and insect repellant.
Post Abortion Care and Harm Reduction
The Women’s Health Project (WHP) started in July 2008, now operates as a social enterprise company separate from the PASMO Guatemala not-for-profit organization. One of the goals is to increase access to long acting reversible contraceptives (LARCs) for women of reproductive age. Doctors, nurses, coordinators, and community outreach workers collaborate with the Ministry of Health in Guatemala to offer a diverse range of family planning methods, including intrauterine devices (IUDs) and implants. Marketing strategies and social behavior change communication (SBCC) are also used to promote and create demand for family planning products and services among patients and providers.
The program launched a social franchise model in 2009 named the Alianza de Profesionales para Salud which includes nearly 250 partnering medical professionals. Since 2013, the project has offered services in both the public and private sector, as part of a total market approach to increase contraceptive access and services to traditionally underserved populations. It has established 61 family planning clinics and trained more than 1,000 providers, a third of which are fully certified as family planning public sector providers.
The project also focuses on providing post abortion care (PAC) and harm reduction activities in Guatemala under the context of the law where abortion is only legal in cases of endangerment of the life of the mother. The program offers providers training and support, health care ethics workshops, and SBCC activities to promote and train providers in the provision of PAC using misoprostol. PSI registers and distributes misoprostol tablets through pharmacies and Alianza de Profesionales para Salud providers. IPC agents are trained in family planning counseling and SBCC. They also provide outreach to the community and refer patients to clinics for PAC and family planning services.
- U.S. Agency for International Development (USAID)
- Embassy of Sweden
- Women’s Health Project
- Corporate Partnership Funding
- Profit of sales from products
- Public sector partners, especially the Ministry of Health
- Local NGOs and civil society organizations
- Private laboratories
- Commercial distributors
- Technical Brief for the Integration of Menstrual Health in SRHR
With this technical brief, which summarises existing literature as well as insights from PSI's network members, the authors hope to support the SRHR work in-country, providing a technical brief for integrating menstrual health in existing SRHR programs.
- Can Online Interventions Enhance HIV Case Finding and Linkages to Care? Comparing Offline and Online Monitoring Data from a Combination Prevention Program with MSM and Transgender Women in Central America (WEPEC166)
Under the USAID Combination Prevention Program for HIV in Guatemala, El Salvador, Honduras and Panama, the Pan American Social Marketing Organization (PASMO) implements offline and online interventions to increase HIV testing services (HTS) uptake among at-risk MSM and transgender women (TW), and link reactive cases to care.
- “Stigma And Discrimination-Free Zones”: An Innovative Approach to Engaging the Private and Public Sectors in Creating More Inclusive Environments for Key Populations in Central America (TUPED509)
Central America's HIV epidemic is concentrated in key populations (KPs). Despite existing HIV laws and policies that respond to KP's specific needs, there is evidence of widespread discriminatory attitudes and practices towards these populations, and stigma and discrimination continue to be important barriers to accessing HIV services and care. In 2016, under the USAID Combination Prevention Program for HIV in Central America, PASMO designed an intervention entitled “stigma and discrimination-free zones” as part of a broader initiative known as Generation Zero, contributing to the goal of “getting to zero discrimination.”
- HIV Care is Fine, But What if I Get the Flu? (THPED546)
In Guatemala, a concentrated epidemic within a highly stigmatizing social context creates an environment fraught with challenges for reaching, testing, and linking vulnerable men who have sex with men (MSM) and transgender women (TW) with HIV testing and care. PASMO commissioned an ethnographic study in 2016-2017 to understand the sexuality, identity construction, health care seeking behaviors, and MSM/TW-health provider relationships to design consumer-focused strategies to facilitate access to HIV services.
- “If you don’t have the courage to go get a test, you won’t have the courage to go for treatment”: Consumer Perspectives on the Introduction of HIVST in Central America (WEPEC187)
The introduction HIV self-testing (HIVST) could overcome stigma-related barriers to HIV testing among Central America''s vulnerable populations, including men who have sex with men (MSM), female sex workers (FSW) and transgender women (TW). The Pan American Social Marketing Organization, through the USAID Combination Prevention Program in Central America, explored knowledge and acceptability of HIVST among vulnerable populations in four studies.
- VIVE, Much More Than Just a Sustainable Condoms Socially-Marketed Brand (TUPEE601)
In response to the HIV epidemic in Central America, Population Services International (PSI) created in Central America, its affiliate, the Pan American Social Marketing Organization (PASMO) in 1996. PASMO's inception project was to launch a regional socially-marketed condom brand, “VIVE,” to improve availability of and access to high quality condoms. Sustainability of the brand and growth of the total market were core principles from the start of the project.
- Shaping the Family Planning Market by Strengthening the Public Sector
PSI considers total market approaches to be critical for achieving universal health coverage, especially when it comes to contraception. This program brief presents cases, supported by several different donors, which take into consideration the total family planning market.
- Crisis in the Triangle: Addressing Adolescent Reproductive Health & Violence Prevention in El Salvador, Guatemala and Honduras
With the largest youth population in history, it is critical to bring together and evaluate the most promising practices from health, violence prevention, protection and education, to develop – in partnership with young people–programs, evidence based research and opportunities that will transform the Northern Triangle countries into safe and healthy places for young people to thrive.
- “Mamá Segura” Delivery Kits Summary
Socios públicos y privados reciben donación de kits “Mamá Segura” para prevenir la transmisión del virus del Zika en mujeres embarazadas Centroamericanas.
Public and private partners have donated "Mamá Segura" kits to prevent transmission of the Zika virus in pregnant women in Central America.
- Task Sharing to Auxiliary Nurses to Expand Delivery of Long-acting Reversible Contraception: PASMO Guatemala’s Experience
National guidelines for family planning in Guatemala prohibit auxiliary nurses from inserting implants, even though in practice they often do. With agreement from MoH and support from USAID’s SIFPO Project, PASMO trained and certified more than 400 MoH providers to insert LARCs (Copper-T IUD and Jadelle implants) in the context of voluntarily and informed choice.