El término “riesgo” ha sido sujeto de múltiples interpretaciones y definiciones, sin embargo es posible establecer dos orientaciones epistemológicas que concentran la forma como este ha sido abordado: en la primera, el riesgo puede entenderse como un hecho medible, objetivo y que puede expresarse en términos de probabilidades y en la segunda, el riesgo, desde aproximaciones antropológicas y sociológicas, aparece como una construcción dependiente de lo sociocultural. En ambas perspectivas el riesgo es objetivado, convirtiéndose así en una categoría indispensable y en lengua franca para la salud pública y las ciencias sociales, por lo cual su definición y su uso son extensos.

Sin embargo, la literatura sobre el tema presenta un amplio espectro que sobrepasa la visión de estos autores y que evidencia que las dinámicas sociales subyacentes a la noción de riesgo van más allá de pensar el riesgo como un producto de la modernidad calificado negativamente. al analizar el riesgo y al pensar en prácticas asociadas a éste –que le otorgan un sentido–, es posible entenderlo bajo una perspectiva en donde, por ejemplo, las prácticas asociadas al self perceived risk y al risk taking no son, necesariamente negativas sino que al contrario, pueden ser altamente valoradas bajo ciertas condiciones sociales tal como lo muestran diferentes trabajos (adkins, 2001; mythen, 2007; reith, 2004; Wilkinson, 2001). Por otro lado, entre las perspectivas que contemplan el riesgo desde aspectos sociales, es posible encontrar una producción de literatura sobresaliente, que se preocupa por las desigualdades sociales, la vulnerabilidad y la estigmatización que inciden directamente en la transmisión de la enfermedad, centrándose particularmente en las inequidades económicas, de clase, raza o etnicidad y género.

Este artículo está inscrito en la discusión sobre el VIH y los aspectos socioculturales asociados a esta enfermedad en la ciudad de Cartagena. Al respecto se pretende plantear el riesgo como una categoría flexible y dependiente de los contextos socioculturales locales. Esta mirada, permite no sólo el reconocimiento de las formas como se establece la percepción del riesgo de adquirir la infección, sino que también permite comprender cómo el riesgo y el VIH están soportados en un red de significados que sostiene y da sentido a prácticas que, desde un punto de vista epidemiológico, posibilitan y potencializan la transmisión de la enfermedad. en este sentido, se busca argumentar cómo elementos propios del contexto sociocultural tales como los roles de género, la estructura familiar y los estereotipos sobre la sexualidad costeña, son fundamentales para entender el comportamiento de la enfermedad en Cartagena. el análisis alrededor del riesgo y el VIH por transmisión sexual, exige explorar el tema del uso o no uso del condón, lo cual aparece como un tema primordial dentro de las dinámicas sociales alrededor de la enfermedad, que además invita a la reflexión sobre el discurso del sexo seguro, tema central de la salud sexual y reproductiva contemporánea, en la que se promueve el condón masculino como la tecnología más eficiente para la reducción de la transmisión sexual del VIH y de otras enfermedades de transmisión sexual.

Introducción

El VIH es una de las enfermedades que en los últimos tiempos ha logrado concentrar gran parte de la atención de las agendas públicas en salud a nivel global. La rapidez con la que se ha propagado la enfermedad en el mundo la ha consolidado como objeto de estudio de las ciencias básicas y sociales. A pesar de las diversas estrategias y planes de control y prevención que se han establecido desde el campo de la salud pública, la incidencia de la enfermedad continúa evidenciando dificultades para lograr el control de la epidemia especialmente en los países que se han denominado por diversos organismos como de mediano y bajo ingreso.

Un estimado de la epidemia de VIH durante el 2008 indica que 39.5 millones de personas fueron directamente afectadas por la enfermedad. Las cifras epidemiológicas ubican a África con la más alta prevalencia, con 25.1 millones de personas infectadas, seguido de Asia con 8.5 millones, Europa oriental y Sur América, cada una con 1.7 millones de personas afectadas (onusida, 2009). en los últimos diez años, Latinoamérica y el Caribe tuvieron el crecimiento más alto de la incidencia, hecho que según varios autores tiene relación con cambios estructurales en los sistemas de seguridad social, la disminución de políticas sanitarias, el incremento en el número de personas viviendo bajo condiciones de pobreza absoluta.

Aunque se han identificado como grupos de riesgo importantes los hombres que tienen sexo con hombres y las trabajadoras sexuales, el rápido crecimiento del contagio en mujeres representa una de las características más importantes del comportamiento de la epidemia actualmente. Es decir que, aunque en un principio los hombres eran los principalmente afectados, la proporción de mujeres que actualmente conviven con el virus ha aumentado dramáticamente. En Colombia, por ejemplo, la relación entre el número de casos de hombres infectados con respecto al de las mujeres ha pasado de 10:1 a 2:1 en veinte años.

Para el caso colombiano, la feminización de la epidemia se ha venido manifestando gradualmente, en particular se resalta la situación de la costa Caribe, región que en los últimos años ha evidenciado un aumento importante en la incidencia de la enfermedad particularmente en el grupo de mujeres jóvenes entre los veinticinco y treinta y cuatro años, seguido del grupo entre los quince y veinticuatro años.

Con el objetivo de prevenir la propagación de la epidemia, en el país se han diseñado campañas de comunicación y educación a nivel nacional cuyo enfoque es primordialmente comportamental e informativo. Bajo esta perspectiva, es frecuente que se asuma que la divulgación de información o de conocimiento en las comunidades va a generar necesariamente un cambio en su comportamiento, de tal manera que los individuos lleven a cabo prácticas saludables. Las campañas de prevención basadas en este enfoque parten del concepto implícito de que los individuos tienen control sobre su salud una vez obtienen determinados conocimientos y que pueden dejar de lado las influencias del contexto social que los rodea. Aunque cada vez más crece la necesidad de comprender y abordar el fenómeno del VIH sobrepasando las teorías comportamentales, sigue siendo limitado el peso que se le da en el campo de la prevención a los contextos socioculturales de la enfermedad.

With the landscape changing dramatically and undeniably for newer generations, we now see stronger opposition from the same proponents that have been waging the abstinence-only fight for years, with much support coming from religious institutions. Just recently, the National Abstinence Education Association began the Parents for Truth campaign aimed at enlisting over 1 million adults in a lobbying effort against comprehensive sex education in public schools. At the same time, health care providers at Planned Parenthood, an organization that supports reproductive freedom, cite studies that show teaching abstinence in schools does nothing to curb sexual behavior for teenagers in the long run. Many say that if things are changing, the way we talk to kids needs to change. The general assumption is that there is more honesty and less sugarcoating of information for our kids, and we could benefit from filtering and articulating the barrage of information about sex so that children can still learn the facts and what is morally sound from their parents. This might mean more pressure on parents to have the “sex talk” at earlier ages.

Is there a problem in having the wrong information versus having no information? What do the competing viewpoints of the media, churches, and parents suggest about how our culture is changing and the ways we think about sex? Why do you think there so much controversy? And what about the bigger issue of sex education and its place in schools, the main source of information for our children: is there a right or wrong way to teach or learn about it?

*Written by Ashley Villarreal, TDN Local Health Reporter

Definition of Community

1: A group of people living together in one place, esp. one practicing common ownership. 2: A group of people having a religion, race, profession, or other particular characteristic in common. 3: A feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals. 4. Ecology a group of interdependent organisms of different species growing or living together in a specified habitat. 

Kenscoff is located in Port au Prince, Haiti.  Although the capital is dense and dusty, and fast, a few miles away and 45 minutes on a tap-tap up hills and curves lies Kenscoff.  The air is considerably cooler and villages are abundant.  People are friendly and say hello to one another and it is here that C.O.H.E.F. hosts a free summer camp every summer for children of all ages.  Elsie Craig, the founder of C.O.H.E.F. liaises with Janie Wynne, a staple in the community, to organize and provide services for the children in the area (who travel near and far, on foot, to attend camp- something they would never experience otherwise).  Young men and women have volunteered every summer for the past 4 years and continue to lead workshops on music, Haitian dance, environment, life skills, yoga, natural medicine, painting, and sports, and arts.  It is here that I met potential young leaders like Amouskov, the tall, basketball playing volunteer who amused the children and kept the camp organized and led meetings every day before and after camp; Blaise, who took a week off from his job at the bank to organize and run the camp with a spiritual demeanor due to his work as a young pastor; Nathalie who made everyone laugh and knows every child, woman and man in Kenscoff and kept children and adults involved in limbo with her infectious voice and laughter; and Taina who volunteered this year with enthusiasm and a zest for life, despite losing her hand in a car accident last year, surviving two of her friends who never made it that fateful day.  Volunteers from Miami, Gonaives and me, from NY attended camp, rose at 6 am daily and worked tirelessly to infuse the youth with the annual theme: “an nou plante la pe,” or let us plant peace.  It is a known fact that children involved in the arts, and children that have an opportunity to be involved with a healthy functional adult are more likely to succeed and less likely to engage in sexual intercourse recklessly.  This means that they are also less likely to fall prey to HIV infection.  Each child at the C.O.H.E.F. camp was given structure and introduced to the idea of empowerment through meaningful interaction and powerful exchange that they would not have experienced otherwise.  The exchange of ideas and the voluntary participation from individuals, and the healthy interaction of each day and each moment give new vision to the word community and to the fight against HIV/AIDS, which lies in prevention and education.  Together, the children, volunteers from abroad, and volunteers from Haiti chanted “an nou plante la pe,” simultaneously sowing the seeds of HIV/AIDS prevention. 

Peace is a word not usually associated with the Batey- an area on the border of Haiti and the Dominican Republic where sugar cane field workers live, work, and constant racial tensions are rampant.  In Batey Ocho something else has been happening and community is alive, sometimes turbulent, and strong in this isolated area.  Within the mix of Dominicans, Dominicans of Haitian decent, and Haitian migrant workers something special is happening.  For 7-weeks over the course of July and August a group of students from NY live, work, and do community service in Batey Ocho.  Through Global Potential, these high school students are prepped for their 7-week life changing journey where they integrate and become one with local residents.  Students like Xiang, Leo and Freddy interned at City Hall and took ownership of projects like a Batey Ocho census.  Other students like Darlene and Stebeli interned at the Batey’s clinic, while Donald, Christian, Jean and Carizma held after school workshops and activities for youth, and worked alongside the Batey’s Peace Corp volunteer.  Vested in the idea of community, the students would coordinate community meetings where human rights and other ideas were discussed.  Alongside the Batey locals students would either spend their mornings in the goat farm planting corn crops, or with the construction project building sidewalks.  Each student lived with a family where despite language barriers their host mom was their “mom,” and their host siblings were “brothers and sisters.”  The bond that was built throughout these 7 weeks is irreplaceable, and so are the ideas, thoughts, and interactions that were shared.  Empowerment was a major point of discussion over the course of my two-week visit at the GP group meetings.  The students talked and explored the rights of women, the difference in the family structures- one man having several families, young women having children, and a lack of education.  In these intimate conversations the group expressed their views on the roles of males and females, and the roles of males and females in the Batey.  Meetings like these helped the students to understand their new community, accept and integrate with their new neighbors and families and grow closer with the youth community in the Batey.  The young women and men from Global Potential served as ambassadors of change by simply being an example of the possibilities that exist outside of the closed community and building solidarity by working side-by-side. 

What is remarkable about the idea of communities like Kenscoff and Batey Ocho is how open they are to others and to sharing their homes, streets, culture, and values.  If communities like this welcome such innovative work, what types of possibilities exist for HIV/AIDS prevention?  It seems almost limitless, and the fight may exist with simply engaging one another through crossing borders and sharing what community means by participating, accepting others and being actionable.  Community does not just mean people living together in one place with similar ideals or beliefs.  The word is also based on interaction and what is left behind in the minds of the people involved.  Whether it is a new habit, a paradigm shift, or an exchange in information- all are relevant to HIV/AIDS prevention, solidifying the fact that through the exchange of ideas and interaction between different communities and individuals we can stop HIV- one community and one conversation at a time.

*Written by Regine Zamor, who was born to Haitian parents that immigrated to the United States in1968.  Born in Brooklyn, New York and raised in both Westchester and Brooklyn, Regine has a diverse background that includes the suburbs, the city, Haiti and its rich culture.  This diverse background is the foundation of her work as co-producer of documentary STRANGE THINGS, program manager at Creative Connections, and as a published freelance writer.

A village in Guinea may seem worlds away.  However, given that Africa is home to 60% of the global population living with HIV/AIDS, any larger perspective on the disease must inevitably look to the continent.  And since Transdiaspora Network’s interventions employ Afro-Caribbean traditions such as storytelling and dance, this article’s sojourn could also be conceived as a return.

Friguiagbe, Guinea, September 2003:

Under a florescent floodlight, some 2,000 people—mostly residents of this town in Guinea’s coastal region—gather until the wee hours of morning for a festival of music, theater and dance.  While the traditional melodies performed here are centuries old, their lyrics are decidedly modern.

  “Use a condom!” chants one ensemble. “Or else stay celibate!”

The Ballet Wassasso from the capital city of Conakry sings the message in French and Susu, the local language, before regaling the audience with a dance of flailing limbs, an explosion of drums, and a shower of prophylactics.

As the number of Africans living with HIV/AIDS approaches 30 million, this event, the Festival of African and Guinean Folklore (FESTAFOLG), has joined an Africa-wide trend integrating AIDS education and traditional culture.  The Festival’s theme: “Stigmatization and discrimination associated with HIV/AIDS, the cultural context.”

“Folkloric culture is an important platform for relaying messages,” said Alfred Houlemou, a Guinean television journalist and the Festival’s principal organizer. Houlemou explained that the West African singer/historian, the griot, traditionally plays a social role not only as a traveling artist but also as a conveyor of practical information from village to village. 

“Will you say to the people of Friguiabe, ‘Hey, I’m going to send you an e-mail with information on preventing AIDS?’ No—the medium is wrong,” said Papa Fadiara Cissokho, who organizes a festival each year in Louga, Senegal. Even drumming, which he says replicates spoken language in many traditional African cultures, is being used to further AIDS awareness. “Rhythm is the best vector of communication in Africa,” he said.

The Paris-based International Council of Organizations of Festivals and Folklore says FESTAFOLG is one of many African festivals that have used folk culture as a platform for addressing societal concerns, ranging from ethnic conflict to sustainable development. Africa Alive!, a network of media-savvy youth organizations that have become one of the continent’s largest AIDS prevention groups, also uses music festivals to relay educational messages in eight countries. And in Cameroon, the John Hopkins University School of Public Health has collaborated with Cameroonian folk artist Paul Kengmo to produce cultural events about AIDS in rural villages known as Project Ah Ta-Ah.

In Guinea, the government’s Department of Culture provided most of the $50,000 needed to produce FESTAFOLG, which featured two-dozen ensembles from Guinea, Ivory Coast and Benin. Meanwhile, a group called PRISM sponsors 10 traveling theater troupes in Upper Guinea as part of its HIV/AIDS education program. On the day of a performance, the group organizes a Mamaya—a dance for members of a particular age group—or commissions a konden—a masked dancer—to parade around the village with drummers to attract villagers to watch interactive theater performances about HIV/AIDS.

The idea of integrating traditional West African arts and HIV/AIDS education dates to at least 1993, when Antonio Francesco, a U.S. Peace Corps volunteer in Diourbel, Senegal, assembled a troupe to bring health education with support from doctors to rural villages. The group toured for several months, performing with permission of village leaders and holding seminars after each show. Two months later, a health team was sent to conduct random interviews in each village, and found that villagers both remembered and understood the message.

PRISM has seen similar results. A survey conducted a year into its program found that compared to the population of Beyla—a control province in Guinea’s forest region which received no HIV/AIDS intervention—Upper Guinean men were twice as likely to use a condom.

But some HIV/AIDS workers warn that purveying health facts through the arts can be risky. “Theater and music and traditional ballets are good for attracting big audiences and presenting basic information,” said Kimberly Ross, HIV/AIDS adviser in Guinea for the U.S. Agency for International Development. “But they haven’t been effective in addressing myths and misconceptions.”

At the Friguiagbe festival, a group called Ballet Saamato performed a scene in which a comb and razor used by an unhygienic barber were said to be contaminated with the HIV virus. Such an infection “is possible,” said Mackenzie Dabo, former coordinator for the Peace Corps’ HIV/AIDS programs in Guinea, “but the chances are slim.”

Many of the festival’s scenes portraying death from AIDS included a sexually promiscuous female character, usually a prostitute. Such depictions are common in educational theater “because they’re funny and easy to represent, but they reinforce the stereotype that only prostitutes and promiscuous people can get AIDS,” Ross said.

Without consultation from knowledgeable AIDS workers, cultural performances may even reinforce misconceptions and add to the societal stigma suffered by many AIDS victims, Ross said. However, most health workers add that simply by addressing the topic of sex openly, folk performances can break through the fundamental taboo about discussing sexuality that is one of the biggest barriers to AIDS education in Guinea and elsewhere in Africa. They say traditional culture is a powerful awareness-raising tool when coupled with accurate information, thoughtful production, and discussions following each performance.

*Written by Joshua Cohen, a PhD student at Columbia University’s Art History Department, who aims to change western framings of African arts.

“Is this the medical clinic?” asks one man, to which a middle-aged woman responds, “I think so,” pointing to a picture of an AIDS ribbon visible through an open first floor window.

The building, as well as the entire city block, is occupied by Via Libre, a non-governmental organization founded in 1990, which, at the time of its creation, operated out of a cramped office and existed only through the volunteer efforts of a small group of healthcare professionals.  Since its inception, Via Libre has provided counseling and mental health services to the HIV-positive population of Lima.  Over the past 19 years, Via Libre has grown exponentially to provide free comprehensive medical services to persons living with HIV/AIDS, create a drug bank for those who cannot afford expensive antiretroviral medication, and engage in creative educational campaigns aimed at preventing the spread of HIV among Lima´s youth and other high-risk populations.  In recent years, Via Libre has created a laboratory dedicated to the development of an HIV vaccine.

When Via Libre was founded, there were no useful statistics about the number of Peruvians living with HIV, and worse, thousands were unaware that they had been infected.  As recently as September 2007, a number of population-based surveys, including surveys by the Peruvian Ministry of Health and the United States Agency for International Development (USAID), reported that there were over 50,000 known cases of HIV or AIDS in Peru, with the capital region accounting for approximately 72% of these. Significantly, the United Nations Joint Programme on HIV/AIDS (UNAIDS) estimates that approximately 35,000 additional Peruvians are HIV positive but unaware of their status.  According to the USAID, sexual transmission accounts for 97% of HIV/AIDS cases in Peru.

In the 1990s, the AIDS epidemic quickly became a burden on Lima´s then-collapsing healthcare system, and private citizens met the challenge of raising awareness about HIV/AIDS.

“Civil society is most responsible for HIV prevention in this country,” says Marcela Coronado, a director at Via Libre. Ms. Coronado, a psychologist who works closely with at-risk youth ages 14-18, believes that there is no organized education in Peruvian schools concerning HIV/AIDS but there is a “growing recognition that [HIV/AIDS] is major public health crisis.”

Coronado explains that Via Libre has gained inroads into at-risk populations by working with community groups, sports clubs, discotecas, and other public spaces frequented by young Peruvians.

“When we work with youth, it is imperative to work with their parents and communities, otherwise parents rightfully will be suspicious of our activities,” said Coronado.

In Coronado´s view, a major challenge is “gaining the respect and friendship of the various communities we work with…our approach differs with each target community.” While Via Libre uses its mobile unit to disseminate information to large groups of people at street fairs, it utilizes a more personal approach when working with teens. “We play games with the youth and get them to loosen up,” said Coronado.

One such game involves asking teens to write anonymously on a small piece of paper the first words that come to mind when they hear certain words, such as “sexuality,” then taping their notes onto a giant ball. The facilitator then passes around the ball, and each teen reads aloud one comment for the group to discuss. “There is a lot of laughing, but the kids are really put at ease and feel comfortable talking about serious issues.” recalls Coronado with a broad smile across her face.

Via Libre´s vision and many innovative approaches to HIV prevention have gained the organization national and international attention, including much-needed funding from the European Union and other international sources.

Many of Via Libre´s youth participants have already gone on to become peer educators and form an integral part of Peru´s fight against HIV/AIDS. As part of Via Libre´s “Communidad Saludable” (Healthy Community) campaign, which is in its second year, some youth participants now work with community leaders and health professionals to organize prevention activities in and around Lima.  Ms. Coronado reports that youth have helped organize HIV awareness fairs, created HIV-prevention brochures, and are presently working with medical clinics around Lima to create spaces where the general public can obtain HIV-prevention materials and find support groups. Ultimately, Coronado explains, “Via Libre wants to create a culture of prevention. We want to start a dialogue that will continue even after our work in a particular community is complete.”

Mr. Mahadik, who has a bachelors degree in counseling and works at an AIDS hospital by day, believes that Indians are “dangerously” uninformed about HIV/AIDS and lack access to accurate information about prevention and treatment.  “In a country that is struggling to educate its youth and to achieve 100% literacy, HIV prevention is not viewed as a top priority.  But it must be.” Mr. Mahadik explains that the desire to inform fellow Indians has driven him to volunteer with the Sanmitra Trust, which, among other things, sponsors street theater relating to HIV/AIDS issues.  “We try to break down stereotypes and societal stigma associated with HIV/AIDS,” says Mr. Mahadik. 

 One of Sanmitra Trust’s street theater pieces tells the story of a carefree Indian youth who finds out that he has contracted HIV.  Faced with this news, he is confronted by his brother who tells the young man that he should leave their family’s home and live on his own.  “I’m not sharing a toilet with you,” exclaims the brother.  When their father gets wind of these developments, he is understanding; he sits the boys down and explains that HIV cannot be spread this way.  “Does anyone know how HIV is spread?” the father asks the growing crowd.

 Mahadik explains that the public has been receptive to Sanmitra Trust’s street theater performances, although noting that in Mumbai, the center of India’s film industry, “everyone’s a critic.”  He believes that there is still a great deal of denial in India about HIV/AIDS; however, people are beginning to recognize that the virus “is killing millions of our countrymen.”  Mr. Mahadik is hopeful that through the work of Sanmitra Trust and other local grassroots organizations and charities, India will be able to overcome the greatest public health crisis in its history.  (View Pictures)

*Written by Ameet Kabrawala, TDN Board Chairman, from Mumbai, India

“Volunteering is an act of heroism on a grand scale.  And it matters profoundly.  It does more than help people beat the odds; it changes the odds.” 

Former President Bill Clinton 

 For many years I have been a volunteer at a faith-based agency that operates a food pantry and used furniture program for needy people.  We serve over one-hundred families each week.  Most of the food we distribute is donated by local churches, organizations and individuals and, except for a paid director and two part-time assistants, all of the work is done by volunteers.  Without its volunteers, the agency would not have the necessary finances to exist.  And, without the agency, hundreds of people each week would not have the basics they so desperately need.  Many of our clients are employed and some have two jobs; many are single mothers and many are elderly and disabled.  What they all have in common is that they need a “helping hand” to make it through the month.  Our agency is able to provide that helping hand through the generous volunteers who donate their time and talents while bringing hope to the people we serve.  And, in turn, our volunteers experience the true meaning of what it means to be members of a caring community. 

In the town where I live there is a nonprofit organization that sends high school students to global destinations (primarily emerging nations) to help build community facilities such as medical clinics, schools, daycare centers, youth facilities, and homes. The students volunteer their time and talents during school vacations and funding to participate in the experience is provided by monies raised by the students.  Through this unique volunteer experience these students are able to begin to establish a pattern of lifelong humanitarian service and are able to gain exposure to global issues and problems facing emerging countries.  And, while working alongside local residents, the students also help to foster relationships between the two cultures.

These examples of how volunteerism can make a difference and can be life changing are well expressed by author and lecturer, Marianne Williamson, who stated “In every community there is work to be done.  In every nation there are wounds to heal.  In every heart there is the power to do it.”  I believe in the power of volunteerism and what can be accomplished when people band together for a common cause.

*Written by Rose Jordan, a friend of Transdiaspora Network

As many of you know, Transdiaspora Network recently conducted a health survey in the Crown Heights community. After analyzing the survey results with  Gretchen Maneval, Lorna Mason*, and Naomi Braine at the Center for the Study of Brooklyn at Brooklyn College, we found that knowledge and impact of HIV/AIDS varied widely among survey participants, a diverse group ranging in ethnicity, age, and gender.

More than 60% of those surveyed reported that they had not participated in HIV prevention education, and 67% reported that they discussed ways to protect themselves only once per year or even less frequently.

Not surprisingly, an overwhelming majority of those surveyed (79%) reported that their HIV prevention education had not incorporated cultural elements at all.

But most interestingly, we found that 50% of those whose education had incorporated cultural heritage described their knowledge of HIV prevention as “excellent” compared to 27.7% of those whose education did not incorporate cultural heritage at all.

So what does this all mean? Sequist is right, but he is also quite wrong. While his study sheds light on the shocking lack of cultural sensitivity among most health care providers, an even more ambitious approach is needed. We must go beyond simple cultural sensitivity or even competency and demand cultural proficiency. Cultural differences need not be a limiting factor merely to be accommodated or referenced, as Sequist’s study suggests. Let’s not just consider culture. Let’s use it. Our rich cultural heritage can provide many of the tools we need to address our most intractable health challenges such as effective HIV prevention. Setting the bar higher – aiming for cultural proficiency – will allow organizations to develop more sustainable prevention programs within a community that improve the capability of its own residents. Let’s take a closer look at everything that our own community has to offer. Harnessing the full potential of our own very powerful cultural resources may well provide the more lasting, more comprehensive, and ultimately more sustainable approach to HIV prevention that we urgently need.

*TDN would like to give a special thank you to Lorna Mason for creating the beautiful graphs you see here.