IN THIS ISSUE
As the proportion of the U.S. population made up of Hispanic people has grown, so has the awareness that cultural, economic and social factors may help to define their needs for—and limit their use of—sexual and reproductive health services. In this special issue of Perspectives on Sexual and Reproductive Health, we present four studies reflecting the diverse needs of Hispanic teenagers and adults.
•Stephen T. Russell and colleagues explore what makes pregnancy prevention programs for Hispanic teenagers effective (see article). The researchers tackle the question from the unique perspective of practitioners working in such programs in California. In interviews with 58 practitioners, they find broad consensus on the essentials of a successful program: It must be culturally sensitive and responsive to the frequent conflicts between traditional Hispanic cultures and predominant U.S.-based values.
When it comes to specifics, however, opinions and practices diverge widely. Cultural sensitivity may mean, among other things, having staff who speak Spanish or having staff whose own experiences ground them in the mores of the community they serve. Addressing the culture clash may mean helping young people navigate educational bureaucracies for which neither they nor their parents are prepared or involving parents in pregnancy prevention efforts, even when such involvement may not come naturally to the parents.
The picture that these practitioners paint is of a dynamic process that is fueled by deeply committed and innovative workers. It is a picture that offers a great deal of insight to programs aimed at promoting Hispanic young people's health and well-being.
•In one of the first quantitative studies of risky sexual behavior in an urban migrant population (see article), Emilio A. Parrado and coinvestigators find that use of commercial sex workers is widespread among foreign-born Hispanic men in Durham, North Carolina. The only characteristics predicting this behavior are "embedded within intractable elements of the migration process": a highly skewed gender mix and the fact that many migrants are married men living apart from their wives for extended periods of time. An encouraging finding suggests that the more time men spend in a new place, the less likely they may be to use commercial sex workers; but this finding is only of borderline significance. Encouraging, too, is the overall high rate of condom use men report for their activity with commercial sex workers; however, their reports also foreshadow declines in use if sex workers are well known to them or have good reputations.
The lessons are clear: HIV prevention efforts for Hispanic migrants need to take into account the social context—especially the isolation and loneliness—in which these men live. Interventions also need to encourage men to use condoms any time they visit a commercial sex worker.
•In California, where Hispanic adolescents have three times the birthrate of their white peers, M. Rosa Solorio and her team find (see article) a lower level of sexual experience among Hispanic women aged 14-17 than among whites and essentially the same level of recent use of family planning services among sexually experienced women in both groups. However, their analysis of data from the California Health Interview Survey reveals that a significantly larger proportion of sexually experienced Hispanic teenagers than of whites have ever been pregnant and obtained family planning care within the last year. When a range of socioeconomic and cultural factors that distinguish Hispanic from white adolescents are taken into account, only pregnancy history is a significant predictor of recent use of services: Hispanic young women who have ever been pregnant have markedly higher odds of recent use than their white counterparts who have never conceived. Solorio and her coauthors comment that for initiatives aimed at increasing the use of reproductive health services by Hispanic teenagers in California, the "main problem" to address is how to encourage these young women to seek care before they become pregnant.
•Although Hispanic communities are disproportionately affected by HIV, AIDS and unintended pregnancy, prevention efforts designed specifically to meet their needs are rare; in general, interventions that involve couples also are rare, despite evidence that they are more successful than programs aimed exclusively at men or women. Theoretically, then, the intervention that S. Marie Harvey and colleagues describe (see article) held great promise: Tailored to the needs of Hispanic couples in East Los Angeles, its three sessions were designed to enhance partners' communication about sexual issues and improve their risk reduction skills. Yet, in a randomized trial, participants were no more likely to be using condoms or effective contraceptives at follow-up than were couples who participated in a single-session program with content more typical of sexual risk reduction efforts in the community. However, both groups showed improvements in protective behaviors.
Harvey and colleagues can only speculate as to the meaning of their findings. But bolstered by findings on the effectiveness of other programs designed for couples, they suggest that merely bringing partners together for preventive interventions may be enough to motivate behavior change.