The Politics Of Planning Culturally Relevant AIDS Prevention Education For African-American Women
D. Elaine Archie-Booker
Abstract: AIDS cases are growing faster among African-American women than for any other ethnicity-gender group. Until a vaccine or cure is available, education offers the primary means to control AIDS. In this paper, I examine a community-based AIDS education provider to determine to what extent were their programs culturally relevant for African-American Women.
Acquired Immunodeficiency Syndrome (AIDS) has become one of the major public health threats in the United States since it first appeared in 1981. The early profile of persons infected with HIV (Human Immunodeficiency Virus), the virus that causes AIDS, was restricted almost entirely to gay and bisexual men. Because men accounted for most cases of AIDS over the first ten years of the epidemic, much of the medical and educational focus had been on the manner in which the disease spreads in men. During this first decade, little attention was directed to the HIV is spread with respect to women because many researchers thought that the epidemic might bypass them. By the early 1990's AIDS cases in the United States were rising more rapidly among women than among any other group (Kalichman, Kelly, Hunter, Murphy, & Tyler, 1993). Most strikingly, AIDS cases are now growing faster among African-American women than for any other ethnicity-gender group (Jenkins, 1992) and constitute 52% of the total AIDS cases among women (Centers for Disease Control and Prevention, 1992). In contrast to gay men, African-American women acquire HIV infection primarily through intravenous drug use and through sexual contact with men who use intravenous drugs (Centers for Disease Control and Prevention, 1996).
Education offers the primary means by which HIV infection can be controlled. Educational programs for African-American women, however, have simply not been successful, as evidenced by the tremendous increase of the disease in this group. This has been attributed largely to the lack of cultural relevancy of these educational efforts (Mays, 1989; Nyamathi, 1990). Most AIDS prevention programs for African-American women fail to account for the large number of socio-cultural influences that are pervasive in the African-American community. These prevention programs have ignored the sexual politics and social inequalities that often exist in the relationships of African-American women (Wingood, Gamble, & DiClemente, 1993). Community-based organizations have served as the primary setting for providing HIV risk reduction interventions, including adult education for populations at risk for contracting the virus. If these educational providers are to be successful, they need to offer programs that are culturally-relevant for the populations they serve. The problem addressed by this study, is that there is no clear empirical evidence to explain why providers of adult education are failing to provide culturally relevant programs for African-American women.
In order to address this problem, I examined the ways in which a large community-based AIDS service organization in the Southeast, referred to in this paper as AIDS Community Services (ACS), attempts to reach African-American women through educational programming. The mission statement of the agency is "to foster and participate in a broad, compassionate response to the Human Immunodeficiency Virus epidemic through advocacy, service, and education" (cited in the ACS annual report). Given the explosion of HIV infection among African-American women in the agency’s service area, it would be expected that its adult education programs would be focused on effectively reaching this population. Thus, the study was guided by two research questions: 1) To what extent are the educational programs offered by ACS culturally-relevant for African-American women, and 2) What social and organizational factors in the program planning process influence whether these programs are culturally-relevant?
Related Literature and Theoretical Framework
Researchers have identified several factors that should be considered when designing AIDS prevention programs for African-American women. Several studies have reported that disenfranchised African-American women, the group at highest risk for HIV infection, are the least capable of negotiating safer sexual practices with their male partners about wearing a condom (Jenkins, 1992; Worth, 1990). Another factor in the sexual politics of African-American women is that many "believe that the practice of birth control, condoms included, is a method of genocide promoted by whites. Those individuals who practice any form of birth control may be viewed as not being loyal to the development of the African-American community" (Mays & Cochran, 1993, p. 149).
Ladson-Billings (1992) provides the theoretical basis for understanding the relationship between culture and teaching. The concept of "culturally relevant teaching" means that the education is designed to fit the culture of persons as the basis for helping them understand themselves and others, to structure social interactions, and to conceptualize knowledge. For this study, culturally relevant education is understood as a pedagogy of opposition that encourage social change by recognizing and celebrating African and African-American culture with the primary goal of empowering people to examine critically the society in which they live (Ladson-Billings, 1992).
Several studies suggested factors that can be used to determine the culturally relevancy of AIDS prevention programs: 1) the race and gender of the message carrier, 2) incorporating the issues and underlying beliefs of a given population into the educational program, 3) the methods used to deliver the educational message and 4) the location and availability of programs.
In addition to examining educational programs for cultural relevance, this study also sought to understand the social and organizational conditions out of which these programs are planned. The framework for examining the planning process comes from Cervero and Wilson (1994, 1996), who argue that program planning is a social activity in which adult educators negotiate interests in social and organizational contexts structured by power relationships.
Methods
The overall research design was a qualitative case study. The unit of analysis was AIDS Community Services (ACS) educational programs and planning processes. It has a staff of more than 90 trained professionals whose work is complemented by the contributions of more than 1,800 volunteers and an operating budget of $3.6 million.
The multiple sources of evidence used to gain a holistic understanding of education at ACS included interviews, document analysis, and participant observation at three major educational programs. A total of 12 semi-structured interviews were conducted at the organizational setting.
In addition, I was also a participant observer in three major AIDS prevention programs. A wealth of ACS documents and records were also examined including the curriculum for AIDS 101, the curriculum for the HIP seminar, and many brochures, annual reports and statistical data records.
The data were analyzed throughout the data collection process and subsequent to it. The first phase focused on assessing the overall educational effort at ACS to determine the cultural relevancy of its AIDS prevention programs. In the second phase, the constant comparative method was used to identify factors in the social and organizational context of the planning process that affected the cultural relevancy of the programs.
Results
This section first presents the evidence regarding the cultural relevance for African-American women of the AIDS prevention programs at ACS. The second part shows that three factors affected the cultural relevance of the educational effort: a) organizational image and financing, b) internal interpretation of the agency’s educational mission, and c) the race and gender of the people who were involved in the program planning process.
Are AIDS Prevention Programs Culturally Relevant?
Overall, the AIDS prevention education programming was not culturally relevant for African-American women because no programs were specifically targeted to this population. This specific programming would have been expected for three reasons: 1) the agency’s mission statement is all encompassing, "to foster and participate in a broad (ital. added), compassionate, response to the HIV epidemic;" 2) the agency does provide programs for several other targeted groups, including the homeless community, the Hispanic community, the African-American community, and the gay, lesbian, and bi-sexual communities; and 3) African-American women have demonstrated the greatest increase in infection rates of any gender/ethnic group in the agency’s service area. The educational programs for the African-American community are designed in an undifferentiated way for the entire community, with little emphasis placed on the special issues for women. The only opportunity for culturally relevant programming was offered during a one-hour breakout session on "Women and AIDS" held during the AIDS 101 workshop. This session, however, was conducted by another community-based agency.
Using the four criteria identified in the literature, this one-hour session was assessed as substantially culturally relevant for African-American women. First, the speaker was an African-American woman who works for an organization that provides AIDS services for this population. She made many references to how she dealt with being HIV positive from both personal and medical perspectives. Second, she spoke about underlying beliefs that related to African-American women, including men’s resistance to using condoms, the negative experiences with the medical system encountered by African-American women with HIV, and the cost of preventing the disease. Third, the instructional media, including a videotape and handouts, used language that was easily understood by the audience. In relation to the fourth criterion, location and availability of AIDS educational services, the workshop did not fare as well. The workshops were held at a church in a predominantly white neighborhood.
As an overall experience, then, the AIDS 101 workshop was not culturally relevant for African-American women. Inasmuch as this program was the only educational effort that had some culturally relevant segments, the overall AIDS prevention education effort at ACS cannot be considered to be culturally relevant for African-American women.
Contextual Factors that Affect Programs’ Cultural Relevance
This study identified three factors in the social and organizational context that influenced the extent to which the AIDS prevention education programs were culturally relevant for African-American women. Organizational image and financing is defined as the public perception of ACS and how this image promotes funding for the agency. Internal interpretation of the educational mission is defined as how staff members understand the agency’s mission. The program planning process focused on the race and gender of the people who make decisions about education at ACS.
Organizational Image and Financing
The perception held by insiders as well as the public is that ACS exists primarily to serve the interests of the "white gay male" community. During the interviews, many staff members and program participants said that the agency is seen as a "white gay" organization. Others indicated that the agency strives to maintain this white gay male image to maintain and attract funding for the organization. This image has a clear historical explanation in that when the organization was created in 1982, most persons with AIDS were white gay males. Thus, many of the people involved in the early development and funding of ACS were white gay males, and this tradition has lasted since that time.
Funding is a major concern for the agency because of its non-profit status. Many people felt that the image of a white gay male organization has been cultivated because that is what generates private funding and donations, which are major sources of revenue for ACS.
Internal Interpretation of Agency’s Education Mission
Many staff members believed that there was not a need for ACS to undertake prevention programs for African-American women because there were other agencies providing these services. Other staff members, however, believed that AIDS prevention programs should be developed by ACS because it is such a large agency and because of the need among African-American women.
There were some conflict around the need for a focus on programming for African-American women. African-American women were seen as outside the mission of the organization in terms of direct service. Any effort to reach these women would have to be a collaborative effort with other organizations for whom this population was a primary audience. Thus, the public image of a white gay male organization was consistent with the dominant internal understanding of its mission.
Program Planning Process
Coupled with the public perception of ACS as a white gay male organization and the dominant understanding of its educational mission, the dearth of African-American women in the planning process was a third important factor explaining the lack of culturally relevant programming at ACS.
African-American women were missing in almost every aspect of the planning process. including the education department, outreach department, or volunteer committee that determined the programming of the AIDS 101 seminar. There was only one African-American woman in management and on the Board of Directors. Finally, the women from the organization that provided the segment on "Women and AIDS" at the AIDS 101 seminar had no involvement in planning.
Discussion
Adult education plays a central role in the prevention of HIV infection in the United States. As the face of AIDS has changed to reflect African-American women, the importance of planning culturally relevant education for this group has increased.
I concluded that the educational planners: a) recognized the importance of providing culturally relevant programming for targeted groups, b) had the knowledge and skill necessary to provide such programming, and c) had the scope of agency mission to provide such programming for African-American women. Yet, with the exception of a one-hour segment of one educational program, these same planners did not offer this most effective form of adult education. Understanding the politics of the program planning process provides an explanation for this lack of culturally relevant programming. As argued by Cervero and Wilson (1994), the purpose, audience, content, and format of any educational program is causally related to the personal and organizational interests of the people who planned it.
As the face of AIDS continues to change, prevention education efforts need to evolve to address the needs of new populations. Given the epidemic’s history in the gay community, many community based agencies have understandably focused their educational efforts there. These agencies have people in the power structure whose interests are primarily related to serving the needs of the gay male population. Therefore, community based agencies will need to develop unique forms of educational programs in order to have a hope of reducing HIV infection in African American women and its resulting personal and social costs.
This study has sought to provide an understanding of the political dynamics of planning such programs in a typical agency. By identifying the factors that constrain and enable culturally relevant programming, funding agencies, institutional leaders, and program planners can better anticipate how to respond effectively and compassionately to the educational needs of African-American women.
References
Centers for Disease Control and Prevention. (1992). Human Immunodeficiency Virus infection in the United States: A review of current knowledge. Morbidity and Mortality Weekly Report, 35, 335.
Centers for Disease Control and Prevention. (1996). HIV/AIDS Surveillance Report, 1996, 8 (1), 10.
Cervero, R. M., & Wilson, A. L. (1994). Planning responsibly for adult education: A guide to negotiating power and interests. San Francisco: Jossey-Bass.
Cervero, R. M., & Wilson, A. L. (1996). What really matters in adult education program planning: Lessons in negotiating power and interests. New Directions for Adult and Continuing Education, no. 69. San Francisco: Jossey-Bass.
Jenkins, B. (1992). AIDS/HIV epidemics in the Black community. In R. Braithwaite & S. E. Taylor (Eds.), Health issues in the Black community (pp. 55-63). San Francisco: Jossey-Bass.
Kalichman, S. C., Kelly, J. A., Hunter, T. L., Murphy, D. A., & Tyler, R. (1993). Culturally-tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: Impact on risk sensitization and risk reduction. Journal of Consulting and Clinical Psychology, 2, 291-295.
Ladson-Billings, G. (1992). Reading between the lines and beyond the pages: A culturally relevant approach to literacy teaching. Theory Into Practice, 31(4), 312-320.
Mays, V. M. (1989). AIDS prevention in Black populations: Methods of a safer kind. In V. M. Mays, G. Albee, & S.Schneider (Eds.), Primary prevention of AIDS (pp. 264-279). Newbury Park, CA: Sage.
Mays, V. M., & Cochran, S. D. (1993). Applying social psychological models of predicting HIV-related sexual risk behavior among African-Americans. Journal of Black Psychology, 19(2), 142-154.
Nyamthi, A. (1990). Designing a culturally sensitive AIDS educational program for Black and Hispanic women of childbearing age. NAACOG’s Clinic Issues Obstetrics Gynecology Neonatal Nursing, 1, 86-88.
Wingood, G. Gamble, D., & DiClemente, R. (1993). A pilot study of sexual communication and negotiation among young African-American women: Implications for HIV prevention. Journal of Black Psychology(2), 190-203.
Worth, D. (1990). Sexual decision making and AIDS: Why condom promotion among vulnerable women is likely to fail. Studies in Family Planning, 20, 297-307.
[Home] [Search] [Conference Proceedings] [Back][Top]