In Nicaragua, PSI’s network member is the Pan American Social Marketing Organization (PASMO). Founded in 1998, PASMO Nicaragua began activities as part of a regional HIV prevention program. Their scope subsequently expanded to other health areas such as reproductive health, including family planning and post-abortion care, as well as prevention and management of gestational diabetes, and Zika prevention.
PASMO estimates that in 2016, its products and services helped avert 14,500 DALYs in Nicaragua, including, by health area:
- 9,200 HIV DALYs
- 5,300 FP DALYs
PASMO’s family planning programs also provided 58,191 couple-years of protection.
HIV prevention efforts in Nicaragua are carried in partnership with partnering local organizations who focus on serving key populations such as men who have sex with men (MSM) and transgender women. PASMO Nicaragua provides technical assistance to these organizations to strengthen their capacity to conduct prevention activities under a combination prevention approach. PASMO Nicaragua is also involved in conducting online outreach targeted to MSM and focused on knowing one’s HIV status, the promotion of HIV testing and counseling (HTC) services, and referrals to structural or complementary services. PASMO also works to ensure that individuals with reactive test results are linked to care, and adequate support is provided to HIV positive persons along the HIV continuum of care.
HIV prevention efforts also include initiatives designed to reduce 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.”
Sexual and Reproductive Health
PASMO Nicaragua is working through the Women’s Health Project to increase the availability of long acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, through the sale and distribution of these products. Providers are trained in the insertion/ removal of IUDs and other LARCs and equipped with high quality affordable products and equipment, enabling them to offer these services to their patients. PASMO Nicaragua also conducts supportive supervisory visits to ensure that patients are receiving quality care. Social and behavior change communication (SBCC) strategies are used to target both consumers and providers to help promote the use of these services and create demand for these products
PASMO Nicaragua operates a network of private providers that benefits both women and health providers. The Alianza de Profesionales para la Salud network offers SRH services that adhere to strict quality standards based on voluntary and informed choice. Members belonging to the network receive trainings to improve the quality of services as well as specialized instruction on various family planning methods. Network members must undergo a certification process before they can officially join the network. In Nicaragua, nearly 150 providers participate across the departments of Managua, León, Chinandega, Jinotega, Estelí, Chontales and Masaya. In addition, nearly 200 private sector providers have been trained in family planning services and IUD insertion/removal and a subset have also been trained in implant insertion/removal.
PASMO Nicaragua, through the aid of the Maverick Collective, has also placed a special emphasis on strengthening youth-friendly services, evidenced through the establishment of its first Social Franchise Clinic, the Red Segura Clinic, which offers integrated, comprehensive, primary care services with a focus on adolescent sexual and reproductive health.
Post Abortion Care
In Nicaragua, there is a rising need for post abortion care (PAC) services as there is no current legal form of abortion in the country. PASMO Nicaragua equips providers with training and support, health care ethics workshops, and BCC activities to educate providers in the use of misoprostol for PAC. PASMO also registers and markets misoprostol to create availability and demand for these services, while working to increase accessibility to post abortion family planning services; all within the context of the local law.
From 2012 to 2017, PASMO Nicaragua worked on reducing maternal and child morbidity that results from birth complications related to gestational diabetes mellitus (GDM), as well as reducing the risk of developing Type 2 diabetes in the future. Working with partners such as private hospitals, the National Autonomous University of Nicaragua, Novo Nordisk, and the World Diabetes Foundation, PASMO worked to build the capacity of health care providers to assess GDM risks, manage GDM, and provide screenings and diagnosis at the maternal health referral hospital. In addition, new social and behavior change communications efforts were implemented to improve pregnant women’s ability to manage GDM. A total of 562 health providers were trained in prevention, diagnosis and management of gestational diabetes in 7 hospitals and 11 health centers. In addition, 18,132 women were screened for gestational diabetes.
PASMO Nicaragua markets and sells condoms and lubricants, in addition to other socially marketed family planning products. These aid to reduce HIV transmission and improve sexual health, a strategy that complements social and behavior change communication activities. PASMO Nicaragua recognizes the importance of directing efforts to improve the availability and accessibility of condoms for the population, especially for those with a greater risk of HIV infection.
To achieve integrated, efficient and sustainable HIV prevention, condom use is crucial; therefore, its promotion should be accelerated. The condom availability and accessibility program focuses on product distribution by means of three distribution channels:
- Traditional, which is specifically made up of pharmacies.
- Non-traditional, which consists of sales points where condom sales do not traditionally take place e.g. convenience stores, supermarkets, “mom-and-pops” stores, warehouses among others.
- High-risk channels, which include sales points such as night clubs, motels, date houses, etc. that are linked or highly associated with commercial sex work.
PASMO Nicaragua uses private sector partners to distribute Zika prevention kits throughout the community. These include informational materials, condoms, insect repellants and other helpful tools to prevent Zika transmission.
- U.S. Agency for International Development
- Women’s Health Project
- Maverick Collective
- Corporate Partner Funding
- World Diabetes Foundation
- Local faith-based organizations
- Local distributors
- Fundación Xochiquetzal
- Quincho Barrilete
- International Planned Parenthood affiliate Profamilia
- Ministry of Health of Nicaragua
- Universidad Nacional Autonoma de Nicaragua
- Red Segura Social Franchise network providers
- “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.”
- “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.
- Insights and Lessons from the Pan American Social Marketing Organization’s (PASMO) Gestational Diabetes Project
Diabetes in pregnancy is a neglected maternal health issue throughout Central America. PASMO is working with private sector health providers across multiple hospitals and satellite clinics in Managua, Nicaragua to offer prenatal clients access to testing, diagnosis and management for hyperglycaemia in pregnancy as part of a broader package of maternal health services.
- Improving Provider Behavior Change Communication and IPC: Best Practices from the Women’s Health Project
This brief describes the challenges faced, strategies developed, and lessons learned by the Women's Health Project. It also proposes a set of best practices for improving productivity of interpersonal communications (IPC) agents and increasing providers' skills and motivation.
- “The ART of Synergy”: Qualitative Study on Barriers to HIV Treatment Adherence among PLWH in Central America
This presentation includes the results from a qualitative study on barriers to HIV treatment adherence among men who have sex with men.
- Barriers and Motivators to Treatment Adherence Among Transgender Women in Central America
PASMO conducted a qualitative study to explore the barriers to antiretroviral therapy adherence faced by HIV-positive transgender women in Nicaragua, El Salvador, and Costa Rica.
- “Sometimes We Take a Vacation”: Qualitative Study on Barriers to HIV Treatment Adherence Among PLWH in Central America
In 2012, PASMO conducted formative research to explore barriers and strategies people living with HIV (PLWH) use to achieve antiretroviral therapy (ART) adherence.
- The Effectiveness of the USAID Combination Prevention Program for Preventing the Spread of HIV Among Key Populations in Central America
PSI/PASMO recently published four peer-reviewed articles on the effectiveness and innovation of the USAID Combination Prevention Program for HIV in Central America.
- Cyber-Educators In Latin America
In Latin America, PASMO has employed cyber-educators to reach young MSM with HIV prevention information through online chat rooms. Check out this video explaining their approach.