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Other themes central to Hispanic culture include sexual silence, familismo, simpatiaand personalismo. Spanish language project materials were subjected to a rigorous translation and back-translation process to create a linguistically appropriate intervention, addressing the use of different Spanish words by Hispanic subgroups to describe the same object or concept. Recruitment was especially challenging because of confidentiality. A collection of topics emerged through the review process, and once they reached the point of data saturation, certain cultural themes became prominent, such as machismo, marianismo, and sexual silence.

A cultural perspective on sexual health: hiv positive and negative monolingual hispanic women in south florida

Prior experience with sexual barriers was discussed at the onset of the sexual barrier component. Equal consideration was given to cultural values and beliefs regarding illness, HIV, and acculturation.

Sexual negotiation was an essential component of the sessions. Do you plan to use either product again?

For instance, in the English language intervention, assertiveness and empowerment were promoted, and women were encouraged to discuss with their partners information on sexual barrier use and the importance of monogamy and limiting the of sexual partners. For some Hispanic women, it was common not to discuss sex with her partner and acquiesce to his sexual needs.

How would your partner feel about using a male condom? Understanding both shared and diverging values and beliefs among Hispanics is critical, especially to the process of developing strategies for sexual risk-reduction interventions for monolingual Spanish-speaking Hispanic women. Study candidates were drawn primarily from hospital outpatient clinics, community health centers, agencies in the Miami-Dade County area, and through participant referrals. Therapists encouraged discussion of emotional responses i.

For example, first-generation Mexican immigrants generally maintained their traditional cultural values, whereas second- and third-generation Mexican immigrants tended to adopt the cultural values of their North American peers, often experiencing familial conflicts because of the cultural divide between them and their elders Falicov, In this context, acculturation represented the degree to which an individual from one culture adapts to the ways of life, customs, values, mores, and languages of the host culture Berry, ; Sullivan et al.

The women were provided with the opportunity to use the sexual barrier products and to discuss their experience with the sexual barriers. Myths and misconceptions were discussed, and women were encouraged to brainstorm problems and to propose solutions.

Prior to the adaptation of the intervention, focus groups with Hispanic women were convened to inform the components of the intervention. Respectful of Hispanic cultural values, the intervention employed more passive sexual negotiation skills, highlighting awareness of safety issues and risk factors e. HIV-positive women were resistant to enroll when they were informed of their potential participation in group sessions.

What made you decide to use the product? The intervention employed a closed, structured group session limited to 10 participants.

Have you or would you recommend male or female condoms to others? Themes were identified through an extensive review of the transcriptions. Alvarez, Vasquez, Mayorga, Feaster, and Mitrani noted various pragmatic barriers to participation, such as poor access to health care, distrust of the medical and mental health professions, lack of health insurance, family responsibilities, and transportation problems.

What do you think it would be like to use this product?

The project targeted psychosocial, behavioral, and environmental factors that might influence the initiation and the maintenance of sexual barriers. How can you become infected with HIV? How can you tell if someone has the virus? The assessors and interventionists were bilingual i. Thus, less-acculturated Hispanic women may be the less assertive partner in a relationship, particularly in the context of sexuality.

It was theorized that offering the intervention in culturally, as well as linguistically, accurate Spanish would improve the likelihood that less acculturated women could receive ificant benefit from the program. In contrast, marianismo embodies the feminine ideal, the opposite and complement of male, in which the woman is expected to emulate traditional roles of being tender, devoted, passive, and submissive to the male Durik et al.

The theory of planned behavior proposes that perceived behavioral control influences intentions and behavior Ajzen, Within this model, the study was deed to influence risk-reduction strategies and future sexual behavior intentions by increasing knowledge, exposure to and use of sexual barriers, improving sexual negotiation skills, and influencing attitudes and beliefs about individual risk behaviors. Participants were followed for 12 months to ascertain sustainability of learned sexual risk-reducing behaviors.

Were there any problems with the products?

What did you use? Sexual silence stems from beliefs endorsed by both men and women such as women should be less experienced and should know less about sex than men. The following questions were asked during the group sessions: In a committed relationship, why might a woman want to protect herself from STDs and HIV?

What are the situations in which a woman might wish to protect herself by using a barrier product and not discuss it with her partner? How would your partner feel about you using a female condom? How could you be certain that someone does not have the virus?

from various studies across the United States with high-risk Hispanics highlight several mediating factors between high-risk behaviors and acculturation: low prevalence of sexual barrier use and HIV testing; low acceptability of sexual barriers male and female condoms ; the influence of poverty, violence, drug dealing, and an environment of illegality; perception of AIDS-related risk; and alcohol use Deren et al.

What was that experience like? These machismo beliefs also reinforce the male-dominated aspect of sexual behavior among the Hispanic community. Role-playing techniques were employed as a tool for women to rehearse positive and appropriate communication with their partners. To address this concern through the cultural brokerage process, the intervention was modified in response to Hispanic cultural values by placing additional emphasis and time on role-playing scenarios that women would typically encounter when discussing the use of male or female condoms with male partners.

Participants were introduced to various methods to reduce the risk of sexual transmission of STDs, such as abstinence, masturbation, monogamy, and correct and consistent use of male and female condoms. In more than half of the Miami-Dade County households, Spanish is routinely spoken, contributing to a complex dynamic of bilingualism and biculturalism among Hispanics in South Florida U. Census Bureau, Cultural values and beliefs influence the experiences of Hispanic women living with and at risk for HIV infection.

Although Spanish is the common language among Hispanic subgroups, careful linguistic translation was employed to for the different colloquial Spanish words used to describe the same object or concept; this included words for sexual terms and relationships. What are some of the things husbands or boyfriends may say when we bring up sexual protection? Project materials were subjected to a rigorous translation and back-translation process to create a culturally and a linguistically appropriate intervention program for monolingual Hispanic women.

The masculinity of a machismo male is often expressed through sexuality. The statements presented were transcribed and translated from Spanish to English from the audio recordings made during the group intervention sessions with HIV-positive and HIV-negative at-risk Hispanic women.

Sample questions included the following: Do you have any concerns about using male or female condoms with your husband or boyfriend? For some Hispanic women, the thought of discussing the use of male or female condoms with their partner was stressful. Recommendations for integrating these culture-specific issues in sexual health interventions for Hispanic women are provided.

Questions included the following: Has anybody in the group or a friend of anyone in the group used male or female condoms? Themes salient throughout the intervention were identified following the review of audio recordings to identify related to sexual health. Machismo and marianismo involve gender stereotypes, valued and sustained within Hispanic culture. Hispanic cultural values and beliefs, such as machismo, marianismo, and sexual silence, emerged throughout the intervention as important determinants of sexual behavior.

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Why might it be a problem to get your partner to agree to use a barrier product? Sociocultural factors common to Hispanics may explain patterns of sexual behavior, which increase risk in this population. Assimilating differences between traditional Hispanic culture and modern American lifestyle has become a source of personal and familial conflict for many Hispanics living in the United States.

Because of confidentiality issues, the women neither identified themselves in the recordings, nor disclosed their HIV status, unless the woman indicated or implied her HIV status while speaking. Three monthly, 2-hour sessions were led by two trained therapists.

Recruiters established relationships with local community organizations and social service agencies serving Hispanic women. What kind of thoughts or feelings might women have about using male or female condoms with their husband or boyfriend?

Women were asked to discuss how they might negotiate use of sexual barriers condoms with their partner s. The project, including the consent, assessment, and intervention phases, was conducted entirely in Spanish. The cultural brokerage process considered how the translation reflected the cultural values of the target populations to ensure culturally equivalent meaning, particularly as related to attitudes and beliefs regarding illness, misconceptions about HIV, and level of acculturation. With a population of 2. Although minority women have shown the largest increase in rates of new AIDS cases in the United States, they remain relatively understudied.

Study candidates were advised that the groups consisted of both HIV-positive and HIV-negative women and that those who were randomized into the group condition were not required to disclose their HIV status. Machismo embodies the masculine ideal where the man is proud, aggressive, and dominant.

Traditionally, Hispanic men are viewed as the head of the household. For this study, most participants were considered to be at a relatively low level of acculturation based on their inability to communicate effectively in English as compared to their fluency in Spanish. Thus, despite behavioral interventions, informational campaigns, and HIV-testing programs, infection rates among Hispanic women continue to increase Amaro, Prevention studies emphasize tailoring interventions to address the needs, beliefs, and values of specific target populations Amaro, HIV prevention strategies are often undermined by disempowering social e.

The Spanish intervention, reflecting Hispanic cultural mores, adopted a more passive, indirect approach to addressing these issues. Intervention manuals, visual materials, and assessment measures were provided in Spanish.