Even though culture is the big problem to confront, there is no way to just change culture. It is more realistic to confront the issues within the culture that need to be changed. A more holistic approach relies on the notion of social responsibility rather than individualistic preservation (32). Also the communicator must be credible to the target population (32). That is to say that it is not quite believable for a rich white male to go into a classroom of poor Hispanic high school females to talk about AIDS. Also for the purposes of attaining the goal of social responsibility, a structured social group is needed (14). Depending on the communities, that could require the cooperation of religious leaders or even drug dealers (14).
Condom use is a very effective way to prevent HIV/AIDS. The only problem is that people are not using them 100% of the time. On the other hand, some people do not use them correctly (39). In another study, in order for condoms to be used, they needed to be introduced at the beginning of relationships (37). This supports the notion that education needs to happen earlier. The study also found that condoms would be more readily accepted if they were promoted as contraceptives rather than for disease prevention purposes (37). Another study found that in a relationship, the one who had the resources (money) more often controlled condom use (31). Naturally, employment also led to more condom use, although to a lesser extent (31).
Past research has shown that Hispanics in general prefer to talk about their HIV concerns with their peers (44), but they prefer to discuss HIV facts with clinical counselors or others directly involved with the epidemic. Results also show that Hispanics prefer input from an older family member in regard to HIV risk reduction behaviors (44).
Many programs already exist in Queens that basically target the same populations, so some original proposed programs to implement in Queens, NY are
1. A new announcement on the subways concerning HIV/AIDS similar to the ones implemented after 9/11 (“If you see something, say something”). This message would only be played at stations where there is a problem in the area. A problem would be defined as having twice the national cumulative AIDS rate. Such a program would have to be negotiated through the MTA (Metropolitan Transportation Authority). Such a program would reach many lower income workers who rely on public transportation and no extra effort needs to be made to reach the target population.
2. A marketing change that may need the help of government to implement. A study about condoms instructions showed that messages were not getting through because of different accepted texts and low levels of literacy (45). The plan is for condom manufacturers to put together accepted Spanish terms that mean the same thing to all Hispanics or to place visual demonstrations on the packaging.
3. The third and potentially most effective program is to implement extracurricular AIDS education programs that are targeted at Hispanics in the public school system. Hispanics are the most populous group (percentage wise) within the NYC public school system (46) so it makes sense to target them. The programs would run beginning in junior high and until the senior year of high school. A study has shown that among Hispanics, almost half had already discussed AIDS with their children between the ages of 10 and 17 (20). This means that parental concern will not be much of an issue. This program also involves peer intervention. Some teachers would train older students to pass on what they have learned to their younger classmates. Not only would this serve to inform more adolescents about AIDS, but it would help develop leadership skills as well.
The potential for these programs is mirrored by the success in the Caribbean in which behavioral change was observed. Condom use increased, people had fewer partners, and people delayed their sexual debuts (19). Hopefully, these proposed programs will have a similar effect on the Puerto Rican and Dominican populations in Queens.