Transcript One Size does NOT Fit All: Addressing Cultural and Developmental Issues in HIV Prevention for Diverse Youth Gary W.

One Size does NOT Fit All:
Addressing Cultural and
Developmental Issues in HIV
Prevention for Diverse Youth
Gary W. Harper, Ph.D., M.P.H.
Department of Psychology
DePaul University
Primary Sources of Funding
• Adolescent Trials Network for HIV/AIDS Interventions (National
Institute on Child Health and Human Development; NIMH; NIDA)
• AIDS Foundation of Chicago
• Chicago Department of Public Health
• DePaul Faculty Research and Development Committee
• DePaul University Research Council
• Health Resources and Services Administration (HRSA)
• Illinois Campus Compact
• National Institute on Mental Health
• Universitywide AIDS Research Program (California)
• Vincentian Endowment Fund
What Do You See?
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Developmental Issues of
Adolescence
• Biological
Changes
• Cognitive
Changes
• Social
Changes
• Identity
• Intimacy
• Autonomy
• Sexuality
Bronfenbrenner’s Ecological Systems
Theory of Human Development
Multiple Factors to Address in HIV
Prevention Programs for Youth
• Developmental (cognitive, identity, autonomy)
• Linguistic/Language (ethnic, youth)
• Social (friends, peers)
• Community/Environmental (neighborhood, city)
• Culture (ethnic, youth, lgbt)
• Societal (oppression, marginalization)
The Five M’s of Adolescent HIV
Prevention Interventions
(For Youth and Interventionists)
• Meaning
• Motivation
• Methods
• Money
• Merriment (Make me Laugh!)
•Ana Pedraza
•Luule Vess
•Michelle Tolliver
•Richard Contreras
•Audrey K. Bangi
Narrative Ethnography: Understanding
Multiple Levels of Narratives
• Story = personal story
• Narrative = shared or common stories
• Dominant cultural narratives related to MexicanAmerican culture
• Community narratives related to the community
agency (Project VIDA) and the neighborhood (Little
Village).
• Personal stories of agency staff, agency clients, and
community members
Narratives as a Way to Give Voice to the
Experiences of the Agency and the People
Individual In-Depth Interviews
• Cultural and community narratives revealed dating and sexual
scripts for young women
• Personal stories uncovered participants’ unique stressors
Focus Groups
• Offered insight into program’s shortcomings
• Provided youth an opportunity to shape and create new
stories for program modification
Non-participant Observations
• Increased understanding of specific stories shared between
participants and facilitators
Additional Sources
• Written text; Rituals; Physical spaces and structures
SHERO’s Program
• Theoretically grounded in the AIDS Risk Reduction Model.
• Addresses a range of social, cultural, and relational barriers to HIV
protection.
• Delivered in group setting by young women from the community.
• Sessions include the following:
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Women’s sexual health
Pregnancy
HIV transmission fact/myths
Dating & Relationships
Self-esteem
Protective barriers
Gangs
Communication/negotiation
Sexual Assault
Sexually Transmitted Diseases
M. Margaret Dolcini
Cherie Boyer
Susan Watson
Heneliaka Jones
Jessica L. Gehle
INITIAL QUALITATIVE STUDY (individual interviews)
LONGITUDINAL STUDY (RDD community recruitment;
quantitative surveys with youth & friends over 1 year)
INTERVENTION DEVELOPMENT (longitudinal study, focus
groups, qualitative interviews, clinical experience, and
other interventions
PILOT TESTING & PROCESS EVALUATION
(quantitative surveys & focus groups)
RANDOMIZED
COMMUNITY TRIAL
PROJECT ÒRÉ Intervention
• Incorporated input from expert in ethnic/cultural studies and local
youth.
• Incorporated rite of passage rituals, community-specific risk data, and
videos made with youth.
• Delivered to small groups of 3-6 adolescents who are members of a
friendship network.
• Emphasizes issues of connectedness among friends and “friends
protecting friends”.
• Theoretically grounded in the AIDS Risk Reduction Model.
• Modules include:
– Introduction and Rites of Passage
– HIV/STI Facts
– Identifying and Assessing Personal Risk
– Commitment to Change
– Condom Knowledge and Skills
– Communication and Negotiation
– Workshop Closure
ADRINKA SYMBOLS (Ghana)
Chicago Team
Miami Team
Jessica L. Gehle
Marco A. Hidalgo
Omar B. Jamil
Alejandro Rodríguez
R. Sebastián Torres
Bianca D. M. Wilson
M. Isabel Fernández
Luis Alzamora
Cesar deFuentes
Nilda Hernandez
Jacob Warren
Juggling Multiple Identities
Gay Identity
Adolescent
Ego
Identity
Ethnic
Identity
Masculinity
Community Recruitment & Screening: 14-22; GBQ; AA/L/W
Quantitative Questionnaire (n=201)
Qualitative Interviews (n=19)
[3(age) x 3(ethnicity) x 2(gay identity)]
Confirmation of Preliminary Themes:
Adult Expert Interviews (n=4)
Confirmation of Preliminary
Themes: Youth Interviews (n=3)
Qualitative Interviews (n=41)
[3(age) x 3(ethnicity) x 2(gay identity)]
Confirmation of Overall Themes: Focus Groups (n=2
groups)
Intervention Model Development
Intervention Model Confirmation: Focus Groups (n=2 groups)
“Man Drawings”
•Participants were asked to represent
how their masculine, sexual, and
ethnic identities were “coming
together”.
•They were asked to physically
represent this by coloring in their
identities in this outline of a figure
(meant to represent themselves)
•The participants selected which
color would represent each of their
identities.
PROXIMAL FORCES
DISTAL FORCES
Messages about
Masculinity
SEXUAL
IDENTITY
ETHNIC
COMMUNITY
Perceived Behavioral
Expectations of Masculine
Identity
PEERS
MEDIA
FAMILY
Life
Experiences
COGNITIVE
PROCESS
Fit/No Fit
(+/-)
Reaction and Response to
Expectations and Perceived
Roles of Men
AFFECT
(+ / - )
COGNITIONS
(+ / - )
BEHAVIOR
(+ / - )
EXTERNAL SOCIETY LABEL
INTERNAL
FORCES
EXTERNAL
FORCES
LOW AWARENESS
(“Always Knew”)
ACTIVITY / EVENT
EXTERNAL SOCIETY LABEL
HEIGHTENED AWARENESS
PERSONAL VIEWS
OF COMMUNITY
INTERNAL LABEL
SELF-LABELING /
IDENTIFICATION
FAMILY
MASCULINITY
SEXUAL IDENTITY
PERSONAL
ATTITUDES
ABOUT ETHNIC
IDENTITY
COGNITIVE
PROCESS
PEERS
Fit/No Fit
(+/-)
STEREOTYPES
MARGINALIZATION
DISCRIMINATION
CULTURE
EVALUATION OF COMMUNITY /
ETHNIC GROUP
COMMUNITY
CONNECTION
(family, peers,
neighborhood)
IDENTITY CONCEPT
HISTORICAL
OPPRESSION
AWARENESS OF SAMESEX ATTRACTIONS
DISTAL INFLUENCES
PROXIMAL INFLUENCES
Perceived Roles
& Responsibilities
Family
Social / Cultural
Pressures
COGNITIVE
EVALUATION
Religion
SI-RELATED
EXPLORATIVE
EXPERIENCES
Peers
Influential Others
Perceived Roles &
Responsibilities
SI Community
Connection
EVALUATION
Socio-Cultural
Messages
+/FIT / NO FIT
-Ethnic/Cultural
Values
-Gender Roles
-Heterosexism
Family
Peers
Influential Others
Religion
AFFECT
(+ / - )
COGNITIONS
(+ / - )
BEHAVIOR
(+ / - )
Thigio Team
Elizabeth Gikulti
Matthew Mburu
Peter Mwangu
Eileen O’Callahan
Nairobi Team
Augusta Muthigani
Julius Ruto
Magnus Bruening
Chicago Team
Leah C. Neubauer
Audrey K. Bangi
Lexa G. Murphy
Bridget Crowell
Omar B. Jamil
Marco Hidalgo
Jessica L. Gehle
Jason Johnson
Tume
Chill
First, Let’s Talk!
Kwanza Tushauriane!
Making Life’s Responsible Choices
Asante Sana!
Questions???
[email protected]