The following paragraphs illustrate the importance of considering a multicultural perspective when working with clients. 

AIDS: A Multicultural Approach

Most white Americans are tragically unaware of how differently other ethnic and cultural groups view the world.  We assume that all cultures look at things the same way we do.  Most of us cannot conceive of ways to think about things that vary from how we were taught.

While this is a problem for all of us, it is a particular problem for human service students and professionals.  The non-white, non-English speaking portion of the United States population is growing very rapidly.  It is estimated that by 2020 half of our population will speak Spanish as their first language. Many different cultural groups comprise the Hispanic population.

Human service students cannot expect to learn about cultural differences in an introductory class.  You can, however, become aware of how little you know about cultural differences and how important it is that you learn as much as you can about the cultures of the people you will be working with in the future, be they clients or colleagues or supervisors.

One example illustrates how important it is to understand other cultures.  In preparation for designing an AIDS education program for four different immigrant groups in a medium-sized city, it was decided that a small research project should be conducted to see if these four cultures would need different approaches.  The differences illustrate how different approaches are necessary.  There is no question about education which does not account for the learner's cultural frame of reference will probably be successful.

It should be noted that these results were obtained through individual interviews with small groups of people and that they cannot necessarily be generalized to all members of these groups or to small groups in other parts of the country.

For Cambodians, any discussion pertaining to sex and sexuality cannot and does not cross gender lines.  So an AIDS education program which includes discussion of sex must separate men and women.  For them, if there is no evidence of pain or symptoms, there can be no illness; therefore, the concept of carrying the HIV virus while asymptomatic is impossible.  Disease prevention is not seen as a priority; birth control is seldom used.  Men use prostitutes when depressed or lonely.  There is a fatalistic approach to life.  It seems unlikely that testing for the virus would be accepted since prevention is not valued, and life is going to happen as it is designed to happen.  Because family is very important and because the elders expect respect from younger people, elders may be convinced that they need to know about AIDS so that they can answer questions of younger people.

Colombians do not concern themselves with their health or seek out care until they are very ill.  Machismo is strong among the men, and having unprotected sex with many partners, male or female, is important to the males.  Monogamous, non-drug-using wives may consider themselves safe from AIDS and uninterested in learning about it.  If they do suggest use of condoms to their husbands, they may get a very strong, often violent negative reaction.  Ninety percent of the Colombians are Roman Catholic and are generally uncomfortable with birth control.  Discussions of sexual matters between children and their parents are infrequent due to discomfort with the topic.  Colombian women need help thinking about how they can discuss AIDS with their children and how they can discuss use of condoms with their husbands.

Local Haitians are defensive about AIDS, perhaps because they were seen early in the outbreak of the disease as primary carriers.  Talking about sex is not taboo, but talking about AIDS is.  Drug use is not prevalent.  Many see AIDS as a curse from God, a way of stopping bad behavior.  There seems to be less extramarital sex, and families seem more stable.  The educational problem, then, is different from that of the Cambodians and the Colombians.  The problem with Haitians is to get them to become involved in AIDS education.  Once this has been accomplished, a more straight-forward educational program can be implemented.

Cape Verdeans were recently identified with a new strain of the virus (HIV-2), so there is a great resistance in the community to any AIDS education.  It is feared that allowing AIDS education to occur will be to admit that they are actually carriers of this new virus.  Sex before and outside marriage is acceptable and common.  For women, sex is supposed to be spontaneous and unplanned or they are seen as prostitutes.  Preventive care is unlikely because taking off time from work for such care is perceived as wasted time and lost income.  Homosexuality is taboo; no one would admit that it occurs.  Some believe that being clean is all one needs to do to avoid AIDS.  So, education programs for Cape Verdeans required working with women to help them with strategies for discussing condom use with their partners.  These programs must be scheduled for non-work hours.

Again a reminder that these may not be valid generalizations; they do illustrate, however, that AIDS education in this city must be done by cultural group and, in some cases, by gender group within the cultural group.  Further, each education program must acknowledge the particular frames of reference, particularly those relating to beliefs about disease, health care, and  birth control.

Source:  Wm. Lynn McKinney, Professor         University of Rhode Island

College of Human Science/Services,  Kingston, RI  02881-0809

Questions to answer:

a.         Describe characteristics of each population that would affect the design of an educational program for AIDS.

b.         What seems to be the most striking differences between cultures?  What are the similarities?

c.         If you had to plan a program to include all four groups, what would be your greatest problem?

d.         Consider AIDS education in your own culture.  How would it differ from those described below?