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HIV program speaks to young Latinos

Thalia Ortiz walks into a classroom of ninth-graders on Denver’s west side hoping to harness some of the very cultural values that others commonly see as a barrier to safe sex practices in the Latino community.

By reframing machismo and marianismo – the distinct gender roles common among Latinos that dictate that men make the decisions and women defer – Ortiz wants to develop positive attitudes toward abstinence and condom use among the youngsters.

And if that happens, it can only help push down the area’s higher-than-average rate of sexually-transmitted infections.

Ortiz, a social worker with Denver Area Youth Services (DAYS), is using ¡Cuídate!, a six-hour curriculum that is one of the only evidence-based HIV prevention programs available for use with Latino youth ages 13-18.

“It really emphasizes HIV prevention in a language the kids will understand,” Ortiz said.

The classes involve role-playing, songs and games to make it fun for the students.

“It doesn’t get too scientific. There’s not too much biology and chemistry,” she said. “But it teaches a basic understanding of what HIV is and what it does to your body and how it can be prevented.”

Curriculum reinforces Latino cultural values

Most importantly, ¡Cuídate! – Spanish for “take care of yourself” – emphasizes how machismo means protecting others, and taking responsibility for keeping oneself and one’s partner safe.

It reinforces traditional Latino concern for familismo – pride in one’s family – and respeto, self-respect.

It also encourages Latinas to view abstinence or condom use as ways to practice that self-respect, and provides them with the skills to insist that partners respect their wishes.

“In the Latino culture, sex is something very private. A lot of parents don’t talk to their children about it,” Ortiz said. “When we talk about it in class, we talk about how sometimes the man feels he makes all the decisions and the woman doesn’t have any decisions in regards to sex.

“And if they were raised with this type of value, machismo, how will that affect their relationships when it comes to sex? And we talk about loyalty to family. If somebody in their family were to become infected with HIV, how would that affect their family?”

The curriculum, developed by University of Michigan researcher Antonia Villarrual, was tested among predominantly Latino youth in Philadelphia and in Mexico before coming to Denver four years ago.

In 2007, DAYS and Colorado Youth Matter won a grant to launch a trial program in Denver’s Abraham Lincoln High School, targeting ninth-grade physical education and ROTC students.

More than 700 students will take part this year

Since then, thanks to continued funding, the program has become a regular part of the school’s health curriculum. Ortiz and others trained in the program have offered it at a number of other schools and youth organizations within the 80204 and 80219 zip codes, which encompass predominantly Hispanic neighborhoods on Denver’s west side.

Providers expect to offer the class to more than 700 young people in Denver this year.

School officials say they are pleased with the results. Gabe Trujillo, principal at Manny Martinez Middle School, where the classes were offered to seventh- and eighth-graders as part of the health curriculum, said he sat in on several classes and was excited at the way the students responded.

“The kids were easily engaged and eager to learn,” he said. “It wasn’t a ‘hee-hee-giggle-giggle’ type of thing. They really wanted the information. They’d start a lot of questions with ‘I’ve heard…’ and then they’d want to know things like if you could get HIV from sharing a soda or from kissing.”

Trujillo said that the program so challenged his students that the school devoted Home Room period twice a week for several weeks to discussing safe sex and HIV questions the students had. He said the students were not only retaining what they learned in class, they were discussing it afterward.

While students are required to get parental permission to participate in the ¡Cuídate! class, Ortiz says she’s never encountered a parent who objects. Instead, she’s encountered parents who come up to her and thank her for making such information available to their children.

Emphasis on HIV prevention, not just sex education

“We emphasize that this is not sex education. It’s HIV prevention,” Ortiz said.

Nevertheless, it does involve a demonstration of proper condom usage.

Ortiz said teaching the program has proven to her how little education many students have in reproductive anatomy.

“You have to kind of prepare yourself for some of the questions they ask,” Ortiz said. “They don’t ask as a joke. They ask because they truly want to know. Some of the girls will ask why a person can’t get pregnant with anal sex or oral sex. They don’t understand the biology, and they’re 15 or 16 years old.”

Statistics bear out this observation:

  • In Colorado, Latino youth have higher rates of teen pregnancy and sexually transmitted infections than non-Latino youth.
  • More than half of all babies born to teen-age mothers in Colorado have Latina moms.
  • Latino youth are also more likely to engage in sex before age 13 and more likely to have multiple sex partners than are non-Latino youth.

In the controlled trials, students who took part in the ¡Cuídate! program were significantly less likely than other youth to later report having sexual intercourse, having multiple sex partners or engaging in unprotected intercourse, researchers found.

For this reason, ¡Cuídate! is promoted by the Centers for Disease Control and Prevention as one of the best programs at reducing HIV risk among young people.

Lack of evidence-based programs

“It’s the only evidence-based sexual health program around right now,” said Courtney Griffin, director of treatment and prevention for DAYS, and one of the co-authors of a 2009 report on the ¡Cuídate! trial at Lincoln.

But she acknowledges that actually doing the research needed to prove the efficacy of such programs is difficult.

“Research takes a long, long time,” she said. “Sometimes there are funding issues. It’s hard to fund longitudinal studies. And to do so with youth, you need parental permission. There are just a lot of barriers and so many variables. It’s hard to get that research done when you’re looking at what actually makes a program good.”

Griffin invites any school or community organization in the targeted zip codes interested in making ¡Cuídate! available to young people to contact her.

“If you get the parental consent forms signed, then we’re thrilled to provide the programming,” she said.

Cost to participate is zero, both for the students and for the school or sponsoring organization.

“We’re an agency that comes in with free programming led by professionals,” Griffin said. “This is just a great way to enrich any young person’s life.”

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