Multicultural Human Services for AIDS Treatment and Prevention

Policy, Perspectives, and Planning

Marcia Bok, Julio Morales

• Éditeur: Routledge
• Année: 2014
• ISBN:
  9781317952855
• Édition: 1
• Sujet: Medizin
• Sous-sujet: Krankheiten & Allergien

This much-needed book presents an introduction and overview of multicultural AIDS issues in social work practice. In a culturally diverse nation, it is essential that professionals look at AIDS within a cultural context in order to find the most effective treatment and prevention strategies for everyone. Emphasizing this need for a culturally sensitive approach, Multicultural Human Services for AIDS Treatment and Prevention increases social workers'often limited knowledge and experience with various social and ethnic groups. It provides specific suggestions and recommendations for program development and acts as a foundation upon which to build new strategies for policy, research, and practice. Multicultural Human Services for AIDS Treatment and Prevention emphasizes the importance of encouraging and sharing research that addresses AIDS and minority populations and assessing prevention, education, and behavioral change strategies from culturally specific and relevant perspectives. It includes chapters focusing on African Americans, Native American Indians, Hawaiians, Puerto Ricans, and Mexican prostitutes--groups that often suffer disproportionately from poverty and its myriad effects. Some topics discussed in the book are:

• helping clients reduce cultural dissonance
• how to enhance behavior change
• child welfare and permanency planning
• empowerment of clients and health care models
• knowledge, attitudes, and behaviors regarding HIV/AIDS
• cultural contradictions and ambivalence in response to AIDS Multicultural Human Services for AIDS Treatment and Prevention is an extremely useful and informative book for all professionals in social work and human services who want to be better prepared to help all groups of people. The book is also an ideal text for upper-level social work students studying topics such as multicultural issues in social work practice, AIDS in a cultural context, and health policy and health care systems.

AIDS Prevention in a Rural Native American Population: An Empirical Approach to Program Development

Elizabeth DePoy

Claire Bolduc

DOI: 10.4324/9781315863825-5

SUMMARY, Currently, the primary form of AIDS prevention is behavioral. Therefore, social workers must anchor preventive efforts on empirical knowledge of the beliefs, attitudes and behavioral norms of the target reference group. This paper presents the development and implementation of a preventive social work intervention project in a rural Native American population in Maine. In order to gain an understanding of the needs of the target group, a pilot study was conducted. Based on the findings of the study, which are presented herein, and knowledge of the cultural norms of the population, a prevention program was implemented. A discussion of implications for multicultural social work practice aimed at AIDS prevention concludes the article.

Introduction

Within one short decade, AIDS has become one of the most serious health and social problems in the world (Haverekos and Edelman, 1988; Doyle, 1988). As AIDS continues to seriously affect all groups of people, many efforts have been undertaken by social workers to prevent transmission (Cournas et al., 1989). Unfortunately, the only preventive mechanisms available at the current time are behavioral (Stall, Coates and Hoff, 1988), limiting social work intervention strategies to those which effect behavior change. Theoretically, a reduction in AIDS would follow from educating persons about the modes of transmission and reinforcing abstinence from behavior that places people at risk for contracting HIV. However, even though major educational efforts have been conducted, the incidence of AIDS continues to increase. Several studies have suggested that educational efforts may not be effective in promoting behavioral change when these efforts are not compatible with the cultural norms, level of knowledge, and patterns of behavior of the diverse reference groups receiving the educational intervention (Des Jarlais and Friedman, 1988; Hall, 1988; Fisher, 1988). The implications of studies such as those conducted by Des Jarlais and Friedman (1988) highlight the importance for social workers to practice from a culturally sensitive perspective when planning AIDS prevention and intervention for diverse ethnic, racial and cultural groups.

This paper presents a social work program in which AIDS prevention was implemented in a rural Native American community in the state of Maine. In the recognition that the Native American community holds customs and cultural norms different from those in which prevention programs previously have been conducted and documented, the program planners aimed to obtain foundation knowledge about AIDS related knowledge, attitudes and behaviors held by population members as a basis for developing an intervention tailored to the needs and norms of the Native American population in Maine.

This article presents the exploratory survey study and the AIDS prevention program which was based on a synthesis of the results of the study with relevant Native American customs.

Literature Review

Since the first documented case of AIDS in 1981, (CDC, 1988), the incidence of AIDS has doubled approximately every 8–10 months, creating a social and health problem of epidemic proportion (Batchelor, 1988). An overview of the literature and research on AIDS transmission and prevention reveals that infection with the AIDS virus is a result of behavior, not of group belongingness or serendipitous events (Doyle, 1988; Des Jarlais and Friedman, 1988; Peterson and Marin, 1988; Stall, Coates and Hoff, 1988; Wheeler, 1989). In the absence of pharmaceutical intervention, behavior change is therefore the only prevention strategy currently available.

Many efforts aimed at reducing behaviors which place an individual at risk for contracting the AIDS virus (herein termed AIDS risk behaviors or ARB) have been initiated since the realization that AIDS has reached epidemic proportions. The majority of these efforts involve disseminating information about AIDS transmission and prevention to those at risk (Wheeler, 1989). However, research reveals equivocal findings regarding the extent to which information acquisition promotes preventive behavior. While McKusic et al. (1985) found that sexual activity in a sample of gay men in San Francisco was not related to knowledge of AIDS risk behavior, Morin (1988) revealed a decline in risk behavior in gay men following their exposure to AIDS information. However, neither study was able to identify the factors which could predict behavior change, although both studies acknowledged that reference group norms were important to investigate further. Des Jarlais and Friedman (1988) suggest that significant factors in the presence and continuation of ARB in a reference group include the behavioral norms and knowledge held by the group members. Interestingly, even though AIDS is a major health and social problem in some minority groups, there is limited literature currently discussing prevention programs which were designed to fit with the cultural norms of those groups. The evidence pointing to the cultural group norms and beliefs as important influences on ARB suggests that social workers need to incorporate knowledge of culturally specific beliefs, norms and behaviors into their planning and implementation. Culturally relevant interventions which aim at behavior change must be developed if social workers are to be effective in promoting the reduction of ARB in culturally diverse groups.

In Maine, a predominantly rural state, there are approximately 4500 off-reservation Indians and 1300 on-reservation residents. In the summer months, the Indian population increases with the influx of migrant Indian blueberry pickers. According to informants from a local agency serving the Native American population, the Indian population holds cultural norms and customs which differ significantly from other populations in which AIDS prevention programs have been implemented. The special customs and structure of Indian society need to be understood by service providers in order to select prevention strategies which will be meaningful and credible in the Indian culture. For example, the elders hold a revered position within the Indian communities and function as transmitters of values to Indian youth (Central Maine Indian Association, 1990). This line of value transition implies that elders should be an integral part of any prevention program which is founded on behavioral change related to values.

According to Red Horse (1988), many American Indians hold beliefs about health which are inconsistent with the medical model that has served as the foundation of most AIDS education and prevention efforts. “… the concept of health includes a sense of harmony among sociological structures and spiritual forces”(Red Horse, 1988, p. 97). Family structures, social roles in small rural communities and gender roles are also factors which require understanding, ...