New Study Documents the Need for 'Culture Sensitive' AIDS Education
A new study suggests that the teen-agers who are statistically at greatest risk for contracting aids--blacks and Hispanics--are not receiving adequate information on how the disease is spread.
Results from the study, published in the current issue of the American Journal of Public Health, indicate that young people in these minority groups are twice as likely as their white peers to harbor misconceptions about how they can avoid aids.
According to experts, the report makes a pressing case for more aggressive and "culturally sensitive" aids-prevention education in minority communities, where the disease has spread at a rate disproportionate to that of the population at large.
Blacks make up 12 percent of the U.S. population but constitute 25 percent of all aids cases in this country, according to the federal Centers for Disease Control. Similarly, Hispanics, who make up 6 percent of the population, constitute 14 percent of all aids victims.
Moreover, minority children account for nearly 80 percent of all pediatric aids cases.
"The group that has the highest risk are only half aware, for example, that condoms can help them," said Ralph DiClemente, one of the study's three authors and a research professor at the University of California at San Francisco's medical school.
Mr. DiClemente and his collaborators surveyed in 1985 some 628 students between the ages of 14 and 17 in San Francisco's 10 largest high schools. Though no formal aids-education program was in place then in the city's school system, about 35 percent of the students said they had heard about the disease in their classes. All of them were enrolled in family-life education classes.
Since the survey was conducted, San Francisco schools have embarked on a comprehensive education effort that has made instruction on aids a curricular requirement in high school and junior high school.
But in 1985, the researchers found that:
While 71.1 percent of white adolescents were aware that using condoms during sexual intercourse would lower the risk of disease transmission, only 59.9 percent of black students and 58.3 percent of Hispanic students were;
More than 70 percent of Hispanic students and 65.9 percent of black students believed, incorrectly, that aids could be contracted by kissing; 43.7 percent of the white teen-agers surveyed did;
More than twice as many Hispanics as whites--35 percent compared with 17 percent--believed they could contract the aids virus by shaking hands with someone who had the disease. Twenty-eight percent of the blacks surveyed also held this belief; and,
Approximately 20 percent of the black and Hispanic students incorrectly agreed with the statement, "All gay men have aids." Under 10 percent of the white students surveyed gave the same answer.
"We can't assume when we give adolescents the right information that they can't harbor misconceptions," Mr. DiClemente said. "You also have to say, 'here's how you can't get aids."'
Mr. DiClemente and other experts said the ethnic disparities in knowledge about aids may be partly due to cultural differences.
"If we're talking about first-generation Hispanic immigrants, we're talking about parents who don't even talk about sex among themselves--let alone to their children," said Arturo Olivas, director of Cara a Cara, a program launched this year in Los Angeles to teach Hispanics how to avoid the disease.
In addition, said Norma Lopez, a health-policy analyst for the National Council of La Raza, there is little information on aids that is specifically geared to minority groups, and what there is is not widely disseminated.
"There's no mystery about why Hispanics are misinformed," she said.
Leaders of local and national education efforts aimed at blacks said they also believed the new findings mirrored the levels of misunderstanding about the disease found in the black population at large.
"There has been a misconception we find among the black community that aids is just a gay, white, male disease," said Evelyn Lowery, who heads the Southern Christian Leadership Foundation's national aids-education efforts. This attitude, she said, has led many blacks to "just turn off" warnings about the disease's spread.
Minority advocates and public4health officials said that, in order to be effective, aids-education efforts must reflect cultural differences.
"It's not enough just taking some booklet and translating it into Spanish or Chinese or Cambodian," noted Ric Loya, a Los Angeles health educator and founder of the California Association of Health Educators.
He said that because 96 percent of his students are Hispanic, most of them from Central America, he often must adapt course matter to meet their needs. An example he cites is the inclusion of Roman Catholic doctrine on birth control when discussing condoms.
Mr. Loya said he also makes it a point to mention that unclean tattoo needles can spread aids as easily as hypodermic needles--a precaution that recognizes the fact that many of his students who are gang members sport tattoos.
Dr. Reed Tuckson, commissioner of public health in the District of Columbia, advised that instruction on the disease also incorporate the frank terms used by minority teen-agers to discuss sexual matters.
"You have to tell the truth about the disease, using technical terms but also translating those concepts so that people will understand what is being said," he said. "What does 'bodily fluids' mean?"
A Slow Response
Beyond the gaps in information caused by differing cultural concepts, several advocates said, is the fact that health agencies, the federal government, and the minority communities themselves have been slow to direct their attention to minority teen-agers.
One reason, Dr. Tuckson said, has been a fear that education campaigns aimed specifically at minorities would draw attention to the prevalence of the disease in those communities and lead to discrimination.
He added, however, that such a reluctance on the part of public-health agencies amounts to a "criminal disservice" to those communities.
"The federal government is beginning to recognize the need," said Norma Lopez of La Raza. She noted that the cdc this spring will make available $3 million for national minority organizations to teach their communities about aids.
"It's a step in the right direction," she said.