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aiaCONNECT
A Global Perspective on Life Sciences Industry News
KEEP IT ON THE DOWN LOW
Here’s a
hypothetical: you are a young twenty-something surfing the web when
a bladder control ad pops up on your screen. Do you click
through? Probably not. As a twenty
something you reject the notion it applies to you. Did we mention
you are a vibrant young woman who’s nine months pregnant? Technology allows
us to instantly communicate with vulnerable target populations, but
how do you reach a target audience that denies it’s the target? According to the
CDC, in 2007, in the areas of the US with HIV reporting, 46% of
African American people live with a diagnosis of HIV. At some point
in their lifetimes, 1 in 16 black men and 1 in 30 black women will
be diagnosed with an HIV infection. For
Hispanics/Latinos the diagnosis rate is 19%. The rate of new AIDS
diagnoses among Hispanic/Latino men is three times that of white men
and for Hispanic/Latina women the rate is five times that of white
women. For U.S. Hispanic/Latino males living with HIV/AIDS, the
number one method of HIV transmission is was sexual contact with
other males. Among African
American and Latino men, many have sex with other men but extremely
few recognize, much less acknowledge they are gay or bisexual. The reason for the
denial stems from their patriarchal cultures. The man rules the
roost and is 100% “male”. Macho is everything. From an early age,
men are given more sexual freedom than women. They are encouraged
to experiment with multiple partners before marriage, and even
after, consider it acceptable to have intercourse with sex workers. Men are expected to
display sexual prowess and exercise authority over women. As such, revealing
their preference for men or potential HIV status can mean rejection
by social groups, guilt about their treatment of their regular
partner or wife, embarrassment or unemployment. Along with their
cultural macho position is an expectation to provide for their
family unit. Losing a job and
failing to provide for the family creates a negative spiral of risky
behaviors: increased alcohol consumption, violence or drug abuse
(which compounds HIV risk even further if it’s intravenous.) Having a job can
also be a risk factor. If the job requires extended periods away
from home (i.e. truck driver), loneliness could trigger unprotected
sex with other men or women, increasing the risk of him bringing HIV
home to his partner. Despite the
problems it can cause and the strong cultural taboos against it, the
fact remains: Hispanic and African American men have sex with other
men. The reasons abound: pleasure, money, compulsion, lack of
available women, (or all of the above) but the denial remains the
same. In these cultures
where machismo is king and being gay or bisexual is unacceptable,
populations vulnerable to HIV are forced to keep it on the down
low. If they don’t have sex with other men, they obviously aren’t
gay and can’t be at risk for HIV or AIDS. Educators targeting gay
Hispanic/African American populations will not only fail to reach
these men, they will turn them away. If men will not
acknowledge their preference for other men, they certainly will not
actively seek care if contracting HIV or take measures to prevent
it. Unfortunately, this goes far beyond affecting their health and
well being. Whether for pleasure, a sense of duty, denial of their
homosexuality or an attempt to hide it, in these cultures, most men
who have sex with men also have sex with women. Completely unaware,
suddenly their wives and/or girlfriends become high risk populations
for HIV contraction as well. The prevailing
macho attitude makes these women more vulnerable to HIV infection
because of the imbalance of decision making power. Women may not be
able to negotiate when and where to have sex and whether or not the
couple will use condoms. There is also an
intrinsic lack of communication in these relationships. In keeping
with her culture, if a woman makes constant homophobic comments, do
you think her male partner will mention his male lover named
“Juanita?” The cultural taboos
placed on sex between African American/Hispanic men hinder the
promotion of safe sex practices and the use and distribution of
condoms among vulnerable populations. If this knowledge is the key
to preventing HIV, again, how do you communicate to an audience
denying or even unaware it’s even at risk? People’s lives are
shaped by the people, places and circumstances around them. Culture
is more than the language we speak, our religion or our
nationality. Culture also encompasses values, beliefs, traditions
and social structures. In this case, to
reshape stigmas and discrimination is to encourage prevention.
Doing this requires informative dialogues about HIV prevention and
care through a person’s local context and culture. Culture needs to
permeate communication programs used to educate these populations. Communication
programs focused on behavioral change from a medical perspective
miss the mark. These culturally inappropriate programs may
reinforce stigmas leading to denial. Since awareness of stigmas and
their impact is the first step in prevention, this is
counterproductive. Instead, you’ve got
to get to the roots of behavior. Look at the values that shape the
lives of your target population and build a culturally sensitive
communication program around them. This will yield a wider impact
on awareness of attitudes and reach a larger population of people
living with HIV or AIDS. Specifically,
programs created at an intimate community level build trust which in
turn spurs behavior change and increases the likelihood of
prevention. For African Americans and Hispanics, this means male
community leaders should play a critical role in HIV prevention and
care. They tend to be respected medical, religious, social or
psychological partners in their community. This position gives them
power to promote or hinder behavioral change as well as prevention
and care. Cultural
differences are not barriers to stopping the spread of HIV. Instead
they create opportunities to intimately engage with otherwise
unreachable target populations. Approach them in a culturally
sensitive way that speaks to their life values and experience. These are high risk
populations that need to be reached. Home and alone on his
computer, you want the middle aged, married Latino who just left his
transvestite lover, “Juanita” to think twice about clicking through
on that condom pop up ad. SHERRY DINEEN ©aiaTranslations
2011 Article cannot be reproduced
without written consent.