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How can your clinic reach Hispanic adolescents with an effective prevention message against sexually transmitted diseases (STDs) and HIV? American Social Health Association (ASHA) in Research Triangle Park, NC, is developing a fresh approach with its new STD prevention program, ¡SALSA! (STDs, Adolescents, and Latinos: Sexual Health Awareness).
Prevention programs for Hispanics, if they are to make a difference, must take into account cultural characteristics, says Lanya Shapiro, ¡SALSA! project manager. Programs must attempt to break the silence about sexuality and incorporate specific cultural aspects to reinforce healthy behaviors, she states.
¡SALSA!’s goal is to increase the availability of bilingual, culturally appropriate STD prevention and education resources for Hispanic teens in North Carolina. If ¡SALSA! is successful, ASHA plans to look into the possibility of partnering with national organizations to modify and disseminate the model, says Tracey Adams, ASHA’s director of community outreach and media relations.
Hispanics constitute a growing segment of the U.S. population, comprising 11.8% of U.S. residents.1 North Carolina has seen a rise in its Hispanic population; the 2000 U.S. Census listed 379,000 Hispanics, well above the 230,000 figure listed in 1995.
U.S. Hispanics are disproportionately affected by STDs, according to ASHA.1 Rates of reportable STDs are known to be higher in Hispanics than in non-Hispanic whites, ASHA states, and Hispanics represent 17% of all AIDS cases diagnosed within the United States.1
Hispanic communities are rapidly growing in the United States, and there is a huge, unmet need for improved health messages — including STD and AIDS prevention messages — within those populations, says Adams.
"ASHA is committed to stopping the spread of STDs, and we believe that the most effective way to do this is through education," says Adams. "To be effective, this education has to incorporate health messages that are accurate, reliable, usable, and accessible; they must be culturally appropriate, building on the knowledge and the strengths that exist in every community."
In Latin America, novelas are a common entertainment medium, typically using photography or drawings to illustrate a story, says Shapiro. More than just an alternative to traditional educational materials, the real-life situations presented in novelas can spark discussions about health issues, model positive health behaviors, and facilitate changing social norms, she notes.
ASHA partnered with El Centro Hispano, a local Latino organization, to create Calenturas, an educational comic-novela on STD prevention. ¡SALSA! staff and members of El Centro’s youth group, Jóvenes Líderes en Acción (Young Leaders in Action), jointly guided the development of the novela’s key themes, story, and artwork. Calenturas was focus group-tested with young Hispanics throughout the state, and national Hispanic leaders in sexual health education provided additional input, says Shapiro.
Written originally in Spanish, Calenturas follows Luis and Ana, a young couple who recently have become sexually active. When her period is late, a worried Ana seeks a pregnancy test and is shocked to learn she has chlamydia. Despite tension and suspicion of betrayal, the diagnosis creates an opportunity for education, increased communication, and ultimately, a commitment to healthier sexual practices in the future, says Shapiro.
The comic-novela has four main themes:
In developing the content of the comic-novela, it was a challenge to balance realism with good (role model) behavior, entertainment with education, and cultural specificity with accessibility, says Shapiro. Teaming ASHA’s expertise in sexual health with the Hispanic adolescents’ expertise in culture- and age-appropriateness was essential, she says. (See "Cultural values are key to reaching Hispanics," in this issue.)
"Writing the script in Spanish [as opposed to translating from English] was key to making it real and natural to the intended audience," Shapiro says of Calenturas. "To underscore the critical health education, an informational page was added, which reiterates the STD facts in an engaging Q&A format and highlights other resources."
¡SALSA!’s next step is to develop and schedule peer education training throughout the state. The program will use Hispanic teens as community education resources. Some 25,000 comic-novelas will be distributed to teens throughout the state through the peer educators’ networks, collaborating agencies, local festivals, and other channels, says Shapiro.
Designed as a three-year project, ¡SALSA! has received approximately $250,000 from the Kate B. Reynolds Charitable Trust to develop, implement, and evaluate the comic-novela and the peer educator program, says Shapiro.
Source: American Social Health Association, Research Triangle Park, NC.
1. American Social Health Association. Hispanics and Sexually Transmitted Diseases. Research Triangle Park, NC: American Social Health Association; accessed at http://www.ashastd.org/news/hisp.html.
Calenturas is available in bulk free of charge to health care providers, schools, and community-based organizations in North Carolina. Those outside of North Carolina can receive a single free copy. To order, contact: