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Keep It on The Down Low

Medical Pharmaceutical Translations • Apr 5, 2011 12:00:00 AM

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.


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