Supporting Latino and Hispanic populations while considering their intersectionality can go a long way in making a difference in their sexual health. Learning some basic cultural competency skills can help you better support marginalized populations.
First some basic facts
According to the Centers for Disease Control and Prevention, in 2014, Hispanics and Latinos made up 17% of the U.S. population, yet accounted for an estimated 23% of diagnoses of HIV infection. Approximately 84% of those cases were attributed to male-to-male sexual contact, and among Hispanic and Latino females, approximately 86% of those infections were attributed to heterosexual contact. For major sexually-transmitted diseases, Hispanics and Latinos experience gonorrhea infection rates of approximately 1.9 times the rate for whites; 2.1 times the rate for chlamydia; and 2.2 times the rate for syphilis.
These disparities can be attributed to a variety of factors, including the amount and depth of sexual health information, resources, and support; access barriers to health care; cultural and social factors; and social stigma.
So what can you do? Whether you are a sexual health professional, educator, religious mentor, or other support professional, here are some factors to consider when working with Latinos and Hispanics in sexual health interactions.
Make no assumptions about language, culture, background, or health literacy
As with any marginalized population, it’s easy to fall into the fallacy of assuming language preference; level of acculturation to the U.S. population; knowledge of sex, sexual beliefs, and sexual practices; level of comfort in disclosing sexual relationships, practices, and beliefs; economic or financial status; and level of support sought or desired.
The best approach to take is to follow their lead. A welcome, a greeting, and a confident handshake establishes comfort, and often individuals will open the conversation by communicating their thoughts in the moment. It is entirely possible that they will not immediately launch into asking any questions about their sexual behaviors, beliefs, and practices. Recognize that this “pre-conversation” process is both essential and fundamental. The goal in this initial interaction is often to build trust, familiarity, and common connection with you – the provider of this information. Allow this first phase to happen, and listen for cues that indicate when they are ready to address the topic at hand.
Avoid immediately jumping into inquiries that are driven by “fact-finding” motivations; these approaches can be off-putting and intrusive. Often information will be volunteered when needed, without the need to request it. Communicate respectfully but attentively. This involves showing curiosity and attentiveness, without appearing to be investigatory or invasive. The true nature of the interaction and need will soon emerge.
Recognize the contextual nature of sex, relationships, and intimacy
In many Hispanic and Latino cultures, sex, sexuality, sexual behavior, sexual identity, and sexual orientation are embedded in other aspects of culture and societal interaction. Sexual behavior is not framed as a separate or isolated aspect of life experience. It is often intertwined in relationships. Some of it is centered in demonstrations of cultural pride and celebration; other times it is deeply personal and perhaps never even shared with others.
A typical task-driven, goal-focused, westernized clinical approach to these interactions can be off-putting to many Hispanics and Latinos for these very reasons. Many Latinos and Hispanics seek and demand relationships with their providers, rather than engaging in simple transactional interventions. Often you will find they hold contextual relationships with all their providers, whether they are doctors, teachers, counselors, ministers, shopkeepers, or even merchants or hair stylists. The interaction is humanistic, not transactional. Consider this when framing interactions around sexual health, sexual behaviors, and sexuality.
Gender can be another factor to consider, just as it is in many other cultures. Consider the possibility that those Latinos or Hispanics who identify as a gender not aligned with yours may pause, alter, or outright avoid interacting with you when it relates to matters of sex, sexuality, or sexual health. It is not personal; it simply is based upon a variety of primarily cultural factors. When possible, seek others who align with that person’s gender. When that is not possible, be respectful of any information shared or questions asked, and consider asking what is only absolutely necessary to accomplish the goal at hand.
Assess needs and respect level of tolerance and boundaries
During interactions, individuals will provide clues about their informational needs and desires. It may be rare that a direct question is asked. More often, the topic is mentioned in ongoing dialogue and conversation. They may “skirt along” the issue, and often may offer a healthy pause. This is your cue to make an offer to share the information. However, do so only with permission. In my experience, permission is almost always given. However, if you proceed to provide that information without first requesting and explicitly receiving permission, it can damage the level of trust that the person has with you moving forward.
Assessing non-verbal cues is critical in these conversations. Although someone may verbally affirm they want to continue receiving the information you provide, pay attention to their actions. Shifting eyes, shifts in sitting position, facial grimaces, or turning away from the discussion are all signs that whatever information you are providing is not being accepted and welcomed completely. In these cases, adjust the conversation quickly to more familiar, more comfortable, affirming life topics. Recognize that whatever information you had provided them to this point is more than they had previously. Take solace in that that.
Foster interactions with long-term supportive relationships in mind
Many Hispanics and Latinos seek to foster longer-term relationships with their providers. They want a point-of-contact. They recognize when they feel comfortable and safe with specific individuals. Because of this, those individuals become the go-to people for future interactions. Do what you can to reinforce and foster that connection. As with most relationships, as interactions increase, trust grows. Often you will be able to communicate information and topics that would never be welcomed by anyone otherwise.
Communicate with relevance and resonance
With many Hispanics and Latinos, context is key. Information, on its face, without demonstrated relevance, is not useful. Storytelling is an excellent way to gather and share information in these situations. If the person is sharing a story about a recent sexual incident, act, or situation, about themselves or about another, take that opportunity to listen closely and interject information when it is relevant and valuable to the dialogue. This approach is both helpful and often helps with remembering your contribution in the future. When you “add” to the story, it becomes part of the cultural narrative in that person’s life. It often is added to the story that others hear moving forward. Take advantage of that opportunity when it presents itself.
Acknowledge and support the role of sexuality in their lives
Recognizing your positionality is absolutely crucial in supporting many Latinos and Hispanics with their sexual health and sexuality. For some, it is utilitarian – it is about procreation, about responsibility and commitment to their mate, and about service to their community. For others, it is a conflicting source of both uncontrollable need and unbearable shame. For some it represents a mechanism of escape, as it results in behaviors meant so squelch desire. And still for others, it represents a mystery that has no real prominence and meaningful definition in their lives.
As a provider, it is not your responsibility to change any of that, unless that is explicitly expressed by the person in your defined interaction. Their belief system, their language in speaking about their sexual health and interactions, their need for information – all if it must be supported. This does not limit your responsibility to correct falsehoods and to point out approaches or beliefs that might not be helpful; by all means, do so, but do so in a non-directive, collaborative, and non-intrusive informative way. The goal of these interactions is to encourage change on their terms, not yours.
Whatever the results, you will find that even offering a differing perspective or a bit of clarification can go a long way in helping someone to enhance or improve their sexual health and sexual beliefs, behaviors, and lives. Learning and growing are an ongoing, iterative, and continuous series of processes. Whatever role you play, rest assured that any step in a more healthy, positive direction can be a fundamental first step in improving a person’s sexual health and well-being.