Transcript Cultural Competency: Silent Population

Welcome!
Cultural Competence:
Silent Population
Harold Thomas, MS
August 5, 2015
Austin, TX
National Community Health
Partners (NCHP)
• Through funding from the Centers for Disease
Control and Prevention (CDC), we work nationwide and in the U.S. territories to provide capacity
building assistance to community-based
organizations.
• Our mission is to educate and assist in
identification and correction of social and health
issues associated with the threat and outbreak of
communicable disease and social dysfunction.
Community High-Impact
Prevention (CHIP)
• An initiative to extend High-Impact Prevention (HIP)
to directly funded community-based organizations.
• HIP has emphasized sustainable, high-impact HIV
testing and screening programs, linkage to and
engagement in care & services, scalable and effective
interventions and public health strategies for high-risk
populations and Persons Living with HIV/AIDS.
Overall Presentation Goal
To provide knowledge, awareness and skills to
enhance the capacity of service providers to work
effectively with men who publicly maintain
heterosexual relationships as well as discreetly
engage in same-gender sex - hereafter referred to as
individuals in the “silent” population
Training Objectives
• Identify how the social, psychological, and
behavioral characteristics of the silent population
affect HIV and other health risks
• Understand how cultural norms and values impact
experiences and behaviors.
• Provide a foundation of knowledge, skills, and
strategies to effectively address the unique
challenges associated with the silent population
Presentation Agenda
• Cultural Competency
• Profile of Individuals in the Silent Population
• Stigma
• HIV and Health Risks
• Cultural Considerations
• Strategies for Working Effectively with the
Silent Population
Profile of Individuals in
the “Silent” Population
What is the “Silent” Population?
Individuals who self-identify as heterosexual
and publicly maintain heterosexual
relationships while engaging in discreet samegender sex
Why not just say “MSM” or “gay”?
• Avoiding the use of labels, especially “gay”,
“bisexual” or “MSM” is important in reaching the
silent population
• The terms “MSM” or “gay” ignore the unique
social and emotional context and risk of HIV
among silent populations
• Further, the use of “MSM” or “gay” may constitute
a barrier to prevention efforts when they are
perceived as insulting or inappropriate
Outward Characteristics
• In heterosexual relationships
• Some are married
• Exhibit traditionally masculine behaviors and
appearances (i.e. don’t “look gay”)
• May subscribe to homophobic or erroneous beliefs
about same-gender sex, and may participate in
homophobic or sexist remarks, discriminatory
behaviors
• Often conceal same-sex relationships even from
close family and friends
Internal Characteristics
• May feel homosexuality, homosexuals,
homosexual relationships, etc. are vile
• Generally do not identify as “gay” or “bisexual”
due to their own shame associated with
homosexuality and/or their concern about being
rejected by social alliances who stigmatize
homosexuals
Perceptions
Individuals in the silent population may subscribe to
beliefs that (for example) :
• Gay and bisexual people are promiscuous
• Homosexuals do not want and are not capable of
having long-term monogamous relationships
• In same-sex relationships, one partner plays the
“male” role and the other the “female” role
Perceptions (cont.)
• Same-sex relationships are unhealthy/abnormal
• Same-sex relationships consist of an older gay
person who psychologically manipulates a
younger, vulnerable person
Stigma
Stigma
• We all Stigmatize
• Insufficient knowledge, disbeliefs and fears about:
1) How HIV is transmitted; and
2) The life potential / capacity of PLWHA
• Moral judgments about people who we assume
have been sexually promiscuous
• Fears about death and disease
• Lack of recognition of stigma
Stigma
Individuals in the silent population:
• May subscribe to HIV-related fear and
discrimination, and therefore distance themselves
from the disease and persons associated with it (i.e.
outwardly gay and bisexual individuals)
• May hide the fact that they engage in same-gender
sex out of fear of losing the support of loved ones
• Thus, addressing HIV-related stigma and fear is
key to working with the silent population
Homophobia
• Individuals who engage in
homosexual behavior while
holding negative attitudes
toward homosexuality often
experience emotional distress
and engage in destructive
behaviors that undermine the
ability to practice safer sex
Addressing Stigma
• It is important for providers
to understand how these
social, emotional, and
behavioral characteristics
impact the silent
population’s unique and
complex HIV (and other
health) risks
HIV & Other Health
Risks
Health/HIV Risk Determinants
The key to working effectively with individuals in
the silent population is to understand their unique
Factors associated with:
Limitations in:
Perceived
Risks
Social
Support
Safer
Behavior
Actual Risks
Barriers to:
Service
Access
Perceived Risks
Self-perception of risk is impacted by:
Knowledge
Societal
Attitudes
Skills
Perceived
Risks
Personal
Beliefs
Scenario # 1

Tell your wife
Scenario # 2

Inside information
Scenario # 3

Outreach-a-go-where?
Environmental & Structural Factors
Culture and individual experiences interact with
structural conditions that affect the environment in
which a person may encounter HIV risk(s)
Structural Factors
Environmental Factors
• Laws, ordnances,
policies, etc.
• People
• Partner notification
mandates
• Things
• Places
Strategies for Working
Effectively with the Silent
Population
Working with the Silent Population
1. Avoid using labels such as “gay” or “MSM”
2. Correct erroneous beliefs about same-sex
behaviors, relationships, and identities
3. Help individuals understand the individual,
cultural, structural and environmental factors that
shape and / or limit their sexual choices
4. Help individuals examine how their beliefs and
behaviors contribute to negative self-esteem and
self-destructive behaviors
Working with the Silent Population
5. Encourage individuals to seek intimacy in the
context of safer sex practices
6. Create an open environment where sexual identity
and sexual behavior can be discussed openly and
independently. For example:
• Men who identify primarily or strictly as
heterosexual can talk about having sex with
other men
• Men who have same-gender sex can appear / be
“masculine”
Working with the Silent Population
7. De-stigmatize homosexuality
8. De-stigmatize condom use…
9. Consider the impact of culture…
10.All individuals - e.g., not just openly “gay” men should be educated about HIV risk related to
same-gender sex
National Community Health
Partners
Training and Technical Assistance:
• Organizational Development & Management
(ODM)
• Public Health Strategies (PHS)
• Prevention with Positives
Organizational
Development
Management
Grant Writing
Board
Development
Leadership
Development
Public
Health
Strategies
Prevention
with
Positives
ARTAS
CHTC
SNS
Medication
Adherence
Social Media
Motivational
Interviewing
EXAMPLES OF TRAININGS WE OFFER
E-Learning Center
National Community Health Partners is building
e-learning courses to help health departments and
community based organizations implement
Community High-Impact Prevention practices while
working with both the HIV+ and at-risk populations
E-Learning Center Current Courses
Community High-Impact Prevention
Motivational Interviewing
Medication Adherence
Condom Distribution
Asset Mapping
Biomedical Strategies for HIV Prevention
Cultural Capacity for Transgender
For more information:
http://www.nchponline.org/nchp-elearning
Thank you!
Harold Thomas
[email protected]
Project Director
3365 N. Campbell Avenue, Suite 141
Tucson, AZ 85719
www.nchponline.org
(520) 795-9756
(520) 887-0432 fax
Toll Free 877-749-3727