Questions and Answers: Inclusive Practice in the Prevention of Sexually Transmitted and Blood Borne Infections among Ethnocultural Minorities

Table of Contents

• Preface
• Acknowledgements
• Introduction
• What Do We Know about Sexually Transmitted and Blood Borne Infections (STBBIS) among Ethnocultural Minorities in Canada
• What Approaches have been used to Support the Health of Ethnocultural Minorities?
• What is the Benefit of Inclusive Practice in the Prevention of Sexually Transmitted and Blood Borne Infections (STBBIs)?
• What are the Social, Structural, or Economic Determinants of Vulnerability to Sexually Transmitted and Blood Borne Infections (STBBIs) among Ethnocultural Minorities?
  • Racism and Discrimination
  • Socioeconomic Status
  • Sex and Gender
  • Substance Use
  • Mental Health and Mental Illness
• What are Key Considerations for Sexually Transmitted and Blood Borne Infection (STBBI) Prevention in Diverse Ethnocultural Environments?
  • Language and Communication Styles
  • Immigration
  • Religion
  • Health Beliefs
  • Perceptions of Sexuality
• What Can I Do to Ensure Inclusive Practice in the Prevention of Sexually Transmitted and Blood Borne Infections (STBBIs) among Ethnocultural Minorities?
• How Can I Help to Build Resilience among Ethnocultural Minorities?
• Concluding Remarks
• Promising Practices
• Additional Resources
• Endnotes

Preface

Questions & Answers: Inclusive practice in the prevention of sexually transmitted and blood borne infections among ethnocultural minorities is intended to address the most commonly asked questions about the prevention of sexually transmitted and blood borne infections (STBBIs)^Footnotei in diverse ethnocultural environments. The goal of this resource is to help community organizations, health professionals, educators and others to develop and implement STBBI prevention interventions and programs that address the needs of ethnocultural minorities. This document examines factors which impact vulnerability to and resilience against STBBIs and provides an evidence base to address disparities in health.

The Public Health Agency of Canada's (the Agency's) Canadian Guidelines for Sexual Health Education (Guidelines),^Footnote1 first published in 1994, and most recently revised in 2008,were developed to help professionals and educators in their efforts to provide broadly-based sexual health education for the prevention of STBBIs. Feedback from a national evaluation of the Guidelines indicated the need for companion documents to provide more detailed information, evidence and resources on specific populations mentioned in the Guidelines. In response, the Agency identified a 'question and answer' format as a means to provide information, resources and promising practices to community organizations, health professionals, and educators to assist in the development of prevention programs among diverse populations. These documents are evidence-informed, use inclusive language and are intended to cover a range of topics that reflect key issues for the prevention of STBBIs among diverse populations. This resource is the fourth in the series of Questions & Answers documents, preceded by documents on sexual orientation, gender identity and sexual health education for youth with physical disabilities.^Footnote2

Acknowledgements

The Agency would like to thank the many contributors whose feedback and guidance ensured that this resource contained current and relevant evidence on STBBIs among ethnocultural minorities. In addition, the Agency would like to acknowledge the staff of the Centre for Communicable Diseases and Infection Control for their contribution to this document.

Introduction

The term 'culture' can refer to shared symbols, beliefs, attitudes, practices and values that are created and negotiated through interactions among people.^Footnote3 Culture is shaped by historical, socioeconomic and political contexts, by relationships both among and between cultural groups, and by the institutionalized attitudes and practices that result.

Culture is one of the primary sources of personal identity and is the foundation upon which people define and express themselves. Cultural diversity results from the influence of many different elements of a person's identity, including gender, race, ethnicity, occupation, geography, class, ability or sexual orientation. It is also shaped by "interculturation", which occurs among and between cultural groups when they interact, learn from, transform, shape and mould each other.^Footnote4

Culture is dynamic and continuously changing. It plays an important role in influencing knowledge, skills and attitudes towards sexuality, as well as sexual behaviours and health outcomes of individuals. For example, cultural factors may influence what is considered to be acceptable and unacceptable sexual behaviour and expression in society. ^Footnote5 Culture may also influence attitudes towards marriage, sexual orientation, gender identity and expression, sexual health education, and sexual relationships.

Disparities in health and illness in Canada across cultural groups emphasize the need to adopt culturally-based illness prevention and health promotion approaches. "Inclusive practice" is a culturally-based approach that aims to address disparities in health and illness experienced by specific cultural groups. It recognizes differences both within and between cultural groups and aims to provide programs that better meet the needs of all individuals. Inclusive practice examines the historical, cultural, socioeconomic and political contexts that shape people's lives. These include structural barriers and social environments that contribute to disparities in accessing and using information and services.

While culture can refer to other social groups that are characterized by age, sexual orientation or disability, the focus of this document is on ethnocultural minorities. ^Footnoteii This resource is intended to help community organizations, health professionals, and educators develop and implement inclusive programs and interventions for the prevention of sexually transmitted and blood borne infections (STBBIs) to ensure that:

This resource is intended to help educators (in and out of school settings), school administrators, curriculum and program planners, policy-makers, and health professionals implement the Guidelines to ensure that:

1. programming is inclusive of the needs of ethnocultural minorities;
2. the experiences of ethnocultural minorities are reflected in all facets of prevention programming;
3. professionals working with ethnocultural minorities are familiar with the concept, elements and benefits of inclusive practice; and
4. professionals working in STBBI prevention are aware of key issues and determinants of vulnerability among ethnocultural minorities and have the necessary tools to address these issues.