Sexual health and HIV health promotion among young culturally and linguistically diverse people in Western Sydney

HIV Australia | Vol. 11 No. 1 | March 2013

ANDREW C STONE and ELIZABETH MLAMBO outline a framework of engagement to support the sexual health of young people from culturally diverse backgrounds.

In many cultures, HIV and sexual health are subjects of great sensitivity, and occasionally can be taboo topics. Dealing with these matters across many cultures poses unique challenges.

Culturally and linguistically diverse (CALD) communities in Australia encompass over 200 different language groups. Each community has its own values and challenges around sexual health and HIV, so a one-size-fits-all approach is not an option.

Western Sydney is home to some of the most culturally diverse groups in Australia (see breakout box below). The Western Sydney Local Health District (WSLHD) and Nepean Blue Mountains Local Health District (NBMLHD) HIV, Hepatitis and Sexual Health Promotion Team (the Team) works with a range of western Sydney populations, both CALD and non-CALD.

We frame our work as the support and development of communities which are ‘Sex Aware, Sex Positive and Sex Responsible.’ Our approach allows us to work in a way which is flexible and adaptable for each of the different populations we work with, but which remains culturally sensitive and respectful.

This approach requires a detailed level of engagement with communities, as what is culturally respectful and acceptable for one community may not be for another.

The success of our approach is evidenced by the fact that in all our work to date, key community leaders, agency workers, and the community members themselves have all been comfortable with our positive framework which positions sexual health as being about awareness, responsibility, and positive attitudes.

This framework guides our approach when working with Western Sydney’s diverse populations of young people.

The building blocks of sexual awareness, positivity and responsibility

Being ‘sexually responsible’ means practising sexual behaviours that ensure the physical, emotional and relational wellbeing of all involved.

In order for this to happen, people first need to be aware of their bodies (and how they function), their feelings, and their desires – this is being ‘sex aware’. They also need to be informed of the risks and benefits attached to sexual expression and how best to manage these.

In addition, it’s important to know where and how to access help in relation to sexual health and expression.

Knowledge of anatomy, disease, condom usage and the location of supportive doctors and health services like sexual health clinics, are not enough to ensure ‘sex responsible’ behaviour. This information has been widely disseminated for 20 years, but for the last decade we have seen rising levels of STIs and HIV.

The Team believes that a person has to affirm their own sexuality as good, and as an individual right, before they can truly care for their body, their mind and their sexual partners: that is, by being ‘sex positive’.

Learning to understand and accept other people’s rights to sexual expression, however different to one’s own choices, is also a part of being ‘sex-positive.’ Being ‘sex aware’ and ‘sex positive’ are the necessary foundations for being ‘sex responsible’.

Engaging young people

In reaching Western Sydney’s young and diverse population with this message, our Team members regularly attend heaving dance parties, muddy soccer pitches, colourful carnivals and busy youth centres.

‘If you want to be effective, you’ve got to go to where the people are,’ says Youth Sexual Health Promotion Officer, Andrew Stone.

Attending dance parties, Migrant Resource Centre homework groups, and soccer tournaments might seem peripheral to promoting good knowledge and practices around HIV and STIs among CALD young people.

However, the Team have found this to be one of the most important components of the project targeting young CALD people.

Ryan Buesnel, manager of Auburn Youth Centre, explains: ‘The process of engaging young people takes time, and developing rapport is more important initially than just running an activity or program.

‘You can’t always expect a young person to immediately feel comfortable discussing significant issues they are facing. Very few adults feel comfortable doing that, so why do we expect it of young people?

‘A gentle and long-term approach is needed if meaningful work is to take place, hence the importance of building trust and strong relationships.’

The Team’s work in Auburn, Blacktown and Holroyd local government areas (LGAs) has been running for over a year.

Much of the work to date has been focused on developing relationships with relevant community workers. Trust is the foundation of any good relationship, and reliability is a key in developing trust.

As such, members of the Sexual Health Promotion Team regularly attend youth interagency meetings; work closely with Migrant Resource Centres in the area (running, for example, sexual health sessions at homework groups); provide training, resources and support to youth centre staff; and attend youth and community events such as cultural festivals.

These relationships have led to centres using existing programs to develop and run targeted sexual health projects. These are based on the sex aware, sex responsible and sex positive philosophy, and therefore better engage with young CALD people who access the centres.

Grants

Programs such as the NSW statewide Sexual Health Week and World AIDS Day Red Ribbon Community Grants offer grants of up to $1000 to organisations who wish to promote sexual health and knowledge of HIV to young people.

The Team has assisted youth organisations in these LGAs in writing applications, and planning and budgeting for events funded through these grant schemes. Team members also make themselves available to attend and participate in funded events and programs.

Grant winners from 2012 included Auburn Diversity Services, the NSW Multicultural Disability Advocacy Association and Football United (see breakout box below). Holroyd Youth Service has also successfully produced HIV awareness multimedia resources with their young people using community grants.

These programs and events are evaluated by the workers in local agencies and centres, allowing them to tailor their future programs and events to the sexual health needs of the specific populations of young people with whom they work.

Sensitivity and cultural appropriateness

The Team works closely with local workers, whose insight and experience has greatly assisted them in ensuring that learning environments are culturally appropriate. For example, through these programs they have learnt that it is considered appropriate across many cultures for sex and relationships to be discussed in a single-gender environment.

For this, separate male and female facilitators are needed. In fact, in some cultures the topic of sex is so sensitive that sexual health information sessions need to be advertised as a ‘men’s/ women’s event’ or ‘health event’.

This may seem disingenuous, but it has been the experience of the Team that participants are invariably glad to have to opportunity to talk about sex in a manner which they experience as being respectful of culture and traditions.

Reaching certain priority populations, for example religious groups, presents another challenge. The support and approval of community leaders is needed to access groups like these, and great care must been taken in both the choice and presentation of educational material.

Taking care not to offend community members is most important but offence is sometimes unavoidable. A concern might be raised after a safe sex demonstration, such as how to put a condom on a plastic penis model – but condom use is a critical ‘sex responsible’ skill, and it is important that all sexually active young people have the skills to practise safe sex.

The Team has found that providing a facilitator who is not part of the CALD group they are working with can be particularly helpful. For some CALD young people, there is a greater level of comfort and belief in the confidential nature of the discussions when they have a facilitator from a different cultural background.

The Team has been developing and implementing a project targeting CALD young people in the LGAs of Auburn, Holroyd and Blacktown people for over a year. Consultations with youth councils, community members and community workers have shown that for any work to effect lasting change, the whole community needs to be involved.

As the project continues, the ‘Sex Aware, Sex Positive, Sex Responsible’ approach will be extended to the broader communities.

Andrew Stone is Youth Health Promotion Officer, the Lemongrove Unit, the HARP (HIV And Related Programs) Team of the WSLHD and NBMLHD. Elizabeth Mlambo is Health Promotion Officer, the Lemongrove Unit, the HARP Team of the WSLHD and NBMLHD.