A Youth Leader's Guide to Building Cultural Competence [PDF]

If you turned to this section without reading the previous sections, STOP! Acquaint yourself with the steps to building cultural competence outlined in the previous pages. Understand that reading the information offered in this section is no substitute for gaining understanding of your own culture, the individual young people in your program and their cultural backgrounds.

This section offers some important information that can help you place HIV/AIDS prevention efforts in a cultural context and perhaps understand some of the beliefs and attitudes of your program participants and their families. Due to the alarming rates of HIV infection among African-American, Latino/Latina and gay male youth, this section will outline some of the reasons that HIV/AIDS prevention messages might be resisted by African-Americans, Latinos/Latinas and young gay men.

Economic Issues

As the HIV/AIDS epidemic moves into its second decade, it is hitting particularly hard in communities in poor, urban communities of color.

African-Americans and Latinos/Latinas experience higher rates of unemployment, poor housing, poor health, early death and inadequate medical insurance than others. Many would argue that the greatest problems facing many African-American and Latino/Latina communities are economic. In the words of a Latino man in a poor neighborhood in New York: "Look around our neighborhood. What do you see? All you see is extreme poverty. We get sick mostly because we are poor. Our children get worse education because we are poor. In order to fight the AIDS epidemic, we have to fight the evils of poverty."¹⁶

For the many African-Americans and Latinos/Latinas whose daily lives are a series of struggles rooted in poverty, worries about HIV/AIDS fall way down on the list of concerns. When finding the next meal, paying the rent or taking a sick child to the emergency room are common problems, concern about a disease that might be fatal in 10 years is unlikely to be a priority.

Childbearing has tremendous meaning for everyone. Various researchers have commented on the fact that for African-Americans and Latinos/Latinas "who live in poverty, having children is often the only way they have to prove that they are socially productive and to demonstrate their manhood or womanhood.^17,18 HIV/AIDS prevention messages that focus on condom use are in direct conflict with this cultural value as condoms prevent pregnancy.

Distrust of Public Health Officials

Society intrudes upon the lives of poor African-Americans and Latinos/Latinas in many ways. Social workers, case managers, law enforcement officials and child protective service workers are constantly telling them what to do. In many ways, the private realm of sexuality is the last area in which they feel a sense of control and power. When public health officials start telling people to change those private sexual behaviors to prevent HIV/AIDS it is understandable why the safer sex messages might be resisted.

There are several reasons that African-Americans in particular tend to distrust public health messages about HIV/AIDS prevention. First, that sense of distrust has roots in the legacy of the Tuskegee Syphilis Study. In that Public Health Service study, black men with syphilis were intentionally given inadequate or no treatment for syphilis and followed for 40 years (1932 to 1972) to see the results of untreated disease. The men were never told that they were not receiving treatment. Today, it is not uncommon for African-Americans to refer to this study and many believe that the government purposefully infected the men with syphilis.¹⁹

Second, conspiracy theories suggesting that the U.S. government introduced HIV into poor, African-American communities are not uncommon and many African-Americans do not believe that the government is telling the whole truth about HIV/AIDS. Third, in the beginning of the epidemic, when so little was known about the mysterious new illness, Haitians were labeled by the government as a "risk group." This early labeling of a group of black people resulted in bad feelings among many African-Americans. Fourth, some of the theories—notably the "green monkey theory"—about where HIV came from in the first place suggest that the virus first appeared in Africa. These theories have been interpreted by some as blaming Africans for the deadly illness.

Denial

Denial of the threat of HIV/AIDS is not unique to African-American and Latino/Latina communities. Most people think that they are safe from infection, even as they continue to engage in risky sexual behavior. In fact, denial of danger, even in the face of facts, is a human trait. How many of us always wear seatbelts, never speed, have quit smoking and follow doctors' advice faithfully?

Many people still believe that HIV/AIDS is a disease that is only a threat to gay white men and African-American and Latino/Latina teens are no different. Creating HIV/AIDS prevention messages and programs that personalize the risk for them is critical.

Even young gay men demonstrate through their behavior that they deny the threat of HIV/AIDS. Recent research shows that young gay men engage in unprotected anal intercourse at higher rates than older gay men and that their HIV infection rates are higher than those of older men.^20,21

There are at least two explanations for this disturbing information. Perhaps the most important is that few young gay men have experienced the level of personal experience with the disease that older men have. Second, there is a growing trend for schools to request that speakers in HIV/AIDS prevention programs refrain from discussing homosexuality, thus eliminating an important educational situations in which lesbian, gay and bisexual issues can be discussed.²²

Religious Issues

Religion has played, and continues to play, a tremendously important role in the lives of many people, including African-Americans and Latinos/Latinas.

African-American churches have always been more than religious institutions, serving as centers for the development of leadership, education and the teaching of the values and traditions of the African-American community. Beginning with slavery, when religion offered slaves the promise of eventual freedom and comfort during captivity, religion has helped African-Americans cope with their social and economic isolation.²³

Churches in the Latino/Latina community play similar roles, as well, moral guidance, spiritual comfort and serving as a community resource in time of need. Over 85 percent of Latinos/Latinas are Catholic. Most of the others are members of Protestant denominations and some follow traditional religions of "espiritismo" and "santerismo" as well.

There are several ways in which religious beliefs have an impact on HIV/AIDS prevention education. First, in almost all religions, homosexuality is seen as immoral, unnatural, sinful and evil. The amount of guilt and shame that many religions create for lesbian, gay and bisexual people is enormous. Religious intolerance is part of what makes it difficult for many lesbian, gay and bisexual people to be honest with themselves and their families about their sexual orientation. Safer sex demands open and honest communication with sexual partners; this can be difficult for lesbian, gay and bisexual people who feel guilt.

Second, the belief that AIDS is punishment from God for immoral behavior is not uncommon. In a small study of African-American women from an urban area, two-thirds believed that AIDS is a fulfillment of prophesy regarding plagues from the Book of Revelations.²⁴ A study of Latino attitudes about HIV/AIDS revealed that their deeply held religious views lead to the belief that AIDS is God's punishment for younger Latinos' corruption by modern U.S. culture. This belief was found to be most common with the older generation of Latinos/Latinas who were raised outside the U.S.²⁵

Third, the Catholic ban on any contraceptive use, even among married couples, makes it difficult to convince religious Catholic Latinos and Latinas to use condoms. Fourth, for Latinos/Latinas in particular, fatalism is a significant barrier to HIV/AIDS prevention. Fatalism is the belief that life is pre-determined and that individuals are powerless to change what happens to them. Those familiar with Latino/Latina culture note that fatalism results from both the tremendous influence of religion and the reality of poverty and that it makes arguments for safer sex difficult.^26,27

Gender Role Expectations

Gender role expectations refer to what is considered to be appropriate and acceptable behavior for men and women. African-Americans and Latinos/Latinas are no different from all other groups in the U.S. in having at least some rigid views about what is okay for men to do and what is okay for women to do. Nor are they immune from mass media messages that tell men to be strong, silent and powerful and women to be pretty, emotional and passive.

Some of the commonly gender role expectations held by African-Americans and Latinos/Latinas, however, are significant for HIV/AIDS prevention work.

The terms macho and machismo are often used when talking about Latino men. The terms have a negative connotation when used by many Americans. The fact that the direct translation of the word machismo is simply "male pride" has been lost in the application of the word to describe men of any ethnicity who are particularly chauvinist.²⁸

A more accurate definition of the term, as understood by Latinos/Latinas, includes men being in control their own lives, providing for and protecting their families, not just being served by women and being skilled, desirable lovers who must "have" many women. The macho ethic provides a major obstacle to condom use. "Condom use is perceived by many to be 'unmanly' and as an obstacle to intimacy and control of sexual relations."²⁹

Machismo also plays a role in homosexual behavior of Latino men. The cultural pressure to marry and have children is enormous; gay Latinos often do get married, in order to conform to their culture. They may still engage in same-sex behavior, in bars or public places, but they live lives as heterosexual, married men. In addition, Latinos who would define themselves as heterosexual sometimes engage in sexual behavior with other men, but as long as they take the "active" male role of inserting the penis, they are not considered to be gay.

Marianismo is the term for the traditional ideal of the submissive Latina who centers her life around her family and is generally obedient to the men in her life. This view of Latinas does not include the reality that within the home, in the arenas of childrearing and family matters, Latinas have much power. Marianismo is an obstacle to safer sex and condom use, however, because a "good wife" is one who submits to her husband's wishes. If he refuses to use condoms, even if he has extramarital affairs, it is very difficult for a Latina wife to insist on protected sex. In addition, motherhood is highly valued in Latino/Latina cultures and women are taught from childhood that their proper role is to be a mother. Condoms prevent disease, but they also prevent conception, and are often resisted on those grounds.

An important fact about the African-American community is the high rates of incarceration for African-American men. Unemployment of African-American men is rampant and too few African-American men can financially provide for their families.

The results of these inequities are several: many African-American men are prevented from carrying out traditional functions of providing for a family and gaining self-respect through work. African-American men from lower socioeconomic classes may try to fulfill these roles in other ways, including through their sexuality. Thus, men who are powerless in many other arenas may cling to patterns of behavior, including sexual risk-taking, that are traditionally male.

African-American women, it has been suggested, might be willing to tolerate objectionable behavior from the men they are involved with because there are not enough men to go around, given how many die early, spend years in prison or are undereducated and unemployed.³⁰

Sexual Attitudes and Behaviors

Homosexuality

Homosexuality is stigmatized, to at least some degree, in all racial and ethnic cultures in the U.S. Lesbian, gay and bisexual people of all colors face rejection from family, church and community. All must struggle for self-acceptance in a world that tells them that who they are is bad.

African-Americans and Latinos/Latinas are no different from other Americans in being fearful and ignorant of gay, lesbian and bisexual people and issues. In many African-American and Latino/Latina communities, homosexuality is viewed as a "white thing" and denial of African-American or Latino/Latina homosexual behavior is common. African-American and Latino/Latina gay/lesbian/bisexual people face at least two struggles: for acceptance as gay people in their own communities, and for acceptance as people of color in the gay community. Finding complete acceptance and understanding in either can be difficult. African-American and Latina lesbians face a third struggle against sexism in their own and in larger communities.

There is a huge difference between sexual identity and sexual behavior. Researchers who have focused on Latino/Latina cultures in particular note that many Latino men who call themselves "heterosexual" in fact engage in homosexual sex. The reasons for this are many. First, being gay is so stigmatized that some Latino gay men choose to live "in the closet," getting married but also having sex with men. Second, other men do not admit their homosexual feelings, but act on them only when under the influence of alcohol or drugs. Third, if a Latino man takes the role of receiving another man's penis in his mouth or anus, he is seen as the passive, female partner. The man who took the active role of inserting his penis is culturally understood to be a heterosexual man; it is only the passive partner who is negatively labeled as gay.³¹

Anal Intercourse

The recipient of anal intercourse is most at risk for HIV infection. Anecdotal evidence from urban areas suggests that anal intercourse is practiced by heterosexual young people as a form of birth control. For some young, unmarried Latino couples, it is used as a way to protect against the loss of female virginity.

Talking About Sex

Safer sex practices require that partners talk to each other about their sexual histories, condom use and sexual acts. These conversations and topics are not easy for anyone, but the general Latino/Latina population in the U.S. has been described by many as sexually conservative. Direct sexual talk in public and private is still basically unacceptable among Latinos/Latinas and health educators may startle and offend their audience by talking about taboo sexual subjects.³²