SR: Volume 32 Number 1

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SIECUS Report - Culturally Competent Sexuality Education: Educating and Empowering Communities, Volume 32 Number 1

Articles are:

Cultivating Advocates in Underserved Communities
Addressing HIV/AIDS: Latino Perspectives and Policy Recommendations
In Their Own Words: Sexuality Within Black Urban Youth Culture
Examples from the Field: Culturally Competent Sexuality Education Programs
Teaching Safer Sex: In English and en Español
Voices from California: Views on Teen Pregnancy From Different Ethnic Groups
Gay-Boy Talk: Discourse for Stopping HIV Infections Among Gay Men

Also in This Issue...

SIECUS Fact Sheet: Sexuality and Young People in Communities of Color

From the President:

"Taking Culture Into Account"

Tamara Kreinin, M.H.S.A.

I am particularly excited about this issue of the SIECUS Report because it is made up entirely of resources, recommendations, and examples from the field. Throughout my career, I have found that nothing re-energizes my own work as much as hearing about the exciting activities that others in this field are undertaking.

In recent years, SIECUS has made a point of bringing our readers more examples of ground-breaking programs from across the country and around the world. We began with a publication from our family project called Innovative Approaches to Increase Parent-Child Communication about Sexuality: Their Impact and Examples from the Field. This publication looked at research on parent-child communication and highlighted diverse programs that took a variety of approaches to this subject. More recently we dedicated an issue of this journal to spotlighting integrated programs that overcame funding and other barriers to simultaneously address HIV, STD, and unintended pregnancy among teens.

For this issue, we wanted to take a different approach and examine culturally competent programs that are working to both inform and empower a community by targeting the activities and materials to a specific group.

The issue of cultural competency is particularly relevant today as many communities are facing increased immigration and/or migration, and overall changes in demographics.

COMMUNITIES OF COLOR

When we talk about culturally competent prevention interventions, whether they focus on HIV, STDs, or unintended pregnancy, we often talk about traditionally underserved communities and think largely of communities of color.

This is understandable because these communities face disproportionate rates of STDs and teen pregnancy. For example, while the United States Census reports that Blacks represent 13 percent of the population, 42 percent of people living with AIDS in 2002 were Black.¹ In addition, while the overall teen pregnancy rate decreased by 25.5 percent between 1990 and 1999, the teen pregnancy rate among Latinas declined only 14.6 percent during that same period.²

The reasons for these disparities are clearly rooted in the complex social, economic, and political landscape of our nation and are difficult to understand completely. Still, the Centers for Disease Control and Prevention suggest several important factors including the distribution of poverty, availability and quality of health care, the level of drug use in some communities, multiple sexual partners, and sexual networks with high STD prevalence.

While these communities continue to struggle, the problems of STDs, HIV, and unintended pregnancy are not limited to those areas that have traditionally been underserved.

WE ARE ALL UNDERSERVED

In fact, the unfortunate truth today is that we are all, to some degree, underserved when it comes to prevention efforts. The federal government has chosen to allow ideology to trump science by continuing to invest exorbitant sums of money in unproven abstinence-only-until-marriage programs. At the same time, they placed restrictions on science-based HIV-prevention programs both domestically and abroad. States are facing some of the worst fiscal crises in recent memory and many state-funded prevention programs have had their budgets dramatically reduced if not slashed entirely. On the local level, resource-strapped schools who are being forced to "teach to the test" are cutting health and prevention programs in order to spend more time focusing on core topics such as math and reading.

When it comes to providing high-quality sexuality education and helping both youth and adults prevent unintended pregnancy and STDs, including HIV, we are in essence a nation made up of underserved communities. Certainly some communities have more resources and are faring better than others; nonetheless we need to do better everywhere and for everyone.

ASPECTS OF CULTURE

We have always believed that providing good programs starts with meeting a community where they are and targeting the activities and materials not only to the community's needs but to their culture as well. Communities may share the common bond of race or ethnicity but there are many other aspects of culture that should be considered such as language, traditions, values, religion, norms, gender roles, immigration, acculturation, family structure, health beliefs, and political power.

Each of these issues can play an important role in how individuals make decisions that affect their sexual health and may need to be addressed or at least understood when planning a prevention program. One powerful example of this is a study conducted a few years ago with Hmong-American adolescents. A majority of these students had accurate basic knowledge of STDs and HIV-87 percent knew that you could get an STD from having sex and 80 percent knew that you could not get AIDS from a toilet seat or a public phone. At the same time, 70 percent of participants believed that there was a tree in Laos that could prevent them from getting "the AIDS virus" if they drank a tea made from its leaves, and 50 percent believed that if they ate a lot of hot peppers they would not get AIDS.³ No intervention with this group of teens would be complete or effective without addressing these beliefs.

In order to be effective, however, program planners need to focus on much more than just health-related knowledge or behavior. They need to know such simple things as what language or dialect is spoken and which expressions or gestures are commonly used and accepted. Planners also need to be aware of other cultural communication issues that might be harder to recognize such as issues of whether eye contact is viewed as polite or rude or if emotions are freely expressed.

CULTURAL COMPETENCE

Many phrases have been used to describe programs that take these issues into account from cultural awareness to cultural sensitivity to cultural competence. In some ways discussing cultural competence ensures that a program will be lacking. The phrase implies outsiders coming into a community and figuring out how to do what they want, rather than what the community wants and needs. It is important to recognize that cultural competence involves such things as language, images that reflect the community, and lessons that take community values into account. But it should go beyond that as we see in many of the programs highlighted in this issue. The community should be involved in shaping the program as is described in "Gay-Boy Talk" and "Cultivating Advocates." Staffing should reflect the community as discussed in the descriptions of Set the P.A.C.E.! and the Promotoras projects. And projects must be willing to adjust like the Hablando Claro program did by allowing participants to help determine the course.

The ultimate goal remains knowing the audience and tailoring the intervention to that audience, whether it is a group of young people bonded by youth culture, a community of adults who speak the same language, or a group of young men who have sex with men who come from different backgrounds but share common experiences.

PROGRAM HIGHLIGHTS

For this issue we solicited information on programs across the country that were doing just that-targeting a specific group of people in order to talk to them most effectively. The programs that we found work with young people and adults in communities bound together by race, ethnicity, religion, experience, and geographical location. We found programs that were teaching fathers and sons to communicate, girls of all ages to be critical thinkers, and adult members of communities to be ambassadors for reproductive health. We found traditional curriculum-based intervention and new ideas such as radio broadcasts.

Most importantly, however, we confirmed our belief that there are numerous dedicated individuals and organizations across the country working to make sexual health a reality in their community. I hope that you are as inspired as I am by these examples of programs that are educating and empowering our communities.

References

U.S. Census Bureau, Race and Hispanic or Latino, 2000, April 2000; and Centers for Disease Control and Prevention, HIV Surveillance Report 2002, vol. 14.
National Campaign to Prevent Teen Pregnancy, "Fact Sheet: Teen Sexual Activity, Pregnancy and Childbearing Among Latinos in the United States," 2003, accessed on line at http://www.teenpregnancy.org on Feb. 6, 2004.
3 B.E. Robinson, et al., "HIV/STD Knowledge, Attitudes, and Risk Behaviors in Hmong-American Adolescents: An Unstudied Population," Journal of Sex Education and Therapy, 24, nos. 1& 2, (1999) 37-46.