‘Condoms+are+for+whitefellas’+–+Cultural+barriers+to+sexual+health

Name: Brodie Pearce Student: 8090815 Tutor: Colleen Niland Tutorial: Wednesdays 4PM-5PM

=**Artefact** =

The artefact I have chosen is part of a campaign by Snake Condoms, a branch of Marie Stopes International that delivers sexual health messages targeted at indigenous Australian youths through social marketing. The NGO Snake Condoms was created following collaboration between Marie Stopes Australia and community and government stakeholders. The slogans are developed by young Australian Aboriginals and radio advertisements for the brand featured Aboriginal television personalities.

=**Public Health Issue** = Following post-WWII migration, Australia has flourished into an extremely multi-cultural society. Current Australian society is a diverse tapestry that reflects the multitude of cultures and/or ethnicities present, each with unique beliefs and health practices. An individual’s adoption of preventative health measures, response to disease and utilisation of health services is affected by their culture and/or social structure. In no area of healthcare is there greater diversity between cultures than in sexual health. Until recently, sexual health initiatives in Australia did not deliver culturally competent messaging and failed to appropriately target priority groups.

=**Literature Review** = In his paper ‘Condoms are for whitefellas: Barriers to Pitjantjatjara men's use of safe sex technologies’, Willis (2003, p. 203) presents a study of the sexual practices of Pitjantjatjara men in central Australia, and provides some of the best examples of the more formidable cultural barriers to sexual health. Upon examination of health records from 1996, Willis found higher infection rates among the Pitjantjatjara for all major STIs, for example ranging from 106 times higher than the national notification rate for syphilis, to 841 times higher for gonorrhoea.

Due to the commonplace prevalence of reproductive and urinary tract infections among the Pitjantjatjara (most men frequently contract infections after ceremonial activity that involves cutting of the penis), genital infections have become disassociated from sex, and are viewed as just another infection that can be dealt with by an injection at a clinic (including HIV). Additionally, preventative measures undertaken by the men only extend to bedding only ‘clean’ partners; despite the fact many infections such as HIV may have no noticeable symptoms.

In regards to condom use, physical handling of the penis, such as is required to apply a condom, was likely to be viewed as sacrilegious and puerile outside ceremonial contexts. In particular, the shape of an erect, subincised penis makes it difficult and uncomfortable to apply conventional condoms. This in conjunction with the association of condoms by appearance with foreskin had lead to a generalized perception that condoms are designed for uninitiated men (that is, boys).

Sexual health education was typically delivered by outsiders (that is, the uninitiated), and using models of clearly uninitiated penises to demonstrate condom application (adding to the perception that condoms are for the uninitiated). As sexuality is central to secret ritual of the Pitjantjatjara, effective sexual education cannot be delivered by outsiders or in non-ritual contexts. Most significantly, as condoms had not been specifically sanctioned in the Pitjantjatjara religious philosophy or by elders, men were uncertain whether use of condoms would comply with their traditional law.

Some of the examples presented by Willis are clear failures of sexual health messaging initiatives that were not culturally appropriate for an acute target audience, but there are also some more general problems across sexual health messaging.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">In studying the acquisition of sexual knowledge amongst a group of young Vietnamese Australian women, Rawson and Liamputtong (2010, p. 343) found that individual culture and familial norms affected where knowledge of sexual health issues was sought from. The respondents wanted discussion of sexual issues but accepted their traditional familial norms of silence around sexual issues. As a result information is sought from sources outside the family structure such as peers and the media. Interviewees stressed that sexual discussions must be culturally appropriate and acknowledge the cultural factors of target audiences, and that the messaging must be sufficiently adequate to inform decision making.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Appropriately addressing cultural needs is something the Australian health-care system typically struggles with, and only as recently as the last decade have directed efforts been made to improve communication within health-care settings without stereotyping patients.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">In a Queensland Health study Allotey, Manderson and Reidpath (2002, p 29) asserted that materials provided to health-care workers at the time to assist in treating culturally diverse patients mostly consisted of ‘ready-made rules’ and checklists that stereotyped patients according to culture. Allotey et al. found many barriers to cross-cultural communication in the clinical setting that centred around assumptions, conscious or not, made by health-care workers. Staff frequently raised their voices to speak to patients with limited English-speaking ability, despite the patients having no hearing difficulty. Assumptions were also made around the meaning of non-verbal communication in different cultural contexts, and staff failed to ask patients directly about their own culture.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">More recent materials distributed to health-care workers, including the materials produced by Allotey et al., provide simple guidelines and //community profiles// that inform the patient care delivered by health-care workers, whilst stressing that every individual is the expert on their own culture.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">In determining the effects of western feminism on equity of care provided to people of non-English speaking background, Blackford and Street (2002, p. 664) found some similar contradictions to Allotey et al. on the part of health-care workers. Some nurses discovered during reflection that whilst they desired to free some of their female patients from apparent culturally defined inequitable parenting roles, they failed to provide women from non-English speaking background interpreters through whom to voice their own concerns. That is, in the pursuit of western feminist norms, the actual wishes of the individual female patients to some extent were ignored.

=<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">**Cultural and Social Analysis** = <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">The Australian healthcare system is typified in research and in the media as culturally unsafe. In some instances this can contribute to gross failure to provide equitable care, and more commonly leads to difficulties in communication between patients, relatives and practitioners. In an increasingly bureaucratic healthcare setting, how can we continue to deliver individualised care, and why are we failing to deliver cultural safety?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Using Max Weber’s social theories one could argue that the increasing bureaucratisation of healthcare organisations is another example of rationalisation. Weber argued that, given time, rational systems inevitably produce irrational results. Adapted to the healthcare setting, this would suggest that, despite a desire to provide high quality and //efficient// healthcare, we are failing to deliver equitable care. That is, it is extremely difficult to account for individual differences and to deliver individualised care within rationalised systems.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Dawson and Gifford (2008, p. 39) found that in regards to Chilean women settled in Australia, very few sexual health initiatives have taken into account the impact of migrants’ social and cultural backgrounds, social changes and the ‘settlement process’ on the cultural construction of gender once settled in Australia. However, despite the potential for good work to be done if we could just appropriately target sexual health education in the community, STI prevalence is something that is inappropriately presented in the media. Thompson, Green, Stirling and James (2007, p. 9) analysed a selection of newspaper articles from 1984 to 2004 covering STIs in indigenous Australians. Among those articles that were emotive, 78% evoked a sense of shock or frustration, and stimulus of 65% of all articles analysed was government-related. Thompson et al. concluded that the overall style of reporting failed to critically examine or challenge government initiatives, and that the potential for print media to educate the general public is poorly utilised.

=<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Analysis of Cultural Artefact = <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">I think the cultural artefact I have selected is an excellent example of successful<span style="font-family: 'Times New Roman',Times,serif;">sexual health messaging. The slogans presented in the advertisements for Snake Condoms are developed in collaboration between health professionals and community stakeholders. Rather than trying to directly educate indigenous youth, Snake Condoms have attached their messages to a brand using clever social marketing, a stark contrast to brochures dropped en-masse from a government office in Canberra.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">References <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Allotey, P., Manderson, L., & Reidpath D. (2002). Addressing cultural diversity in Australian health services. //Health Promotion Journal of Australia, 13(2),// 29-33. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/fullText;dn=200209446;res=APAFT

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Blackford, J., & Street, A. (2002). Cultural conflict: The impact of western feminism(s) on nurses caring for women of non‐English speaking background. //Journal of Clinical Nursing,11,// 664-671. doi:10.1046/j.1365-2702.2002.00680.x

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Dawson, M. T., & Gifford, S. M. (2008). Social change, migration and sexual health: Chilean women in Chile and Australia. //Women & Health//, 38, (39-56). doi: 10.1300/J013v38n04_03

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Rawson, H. A., & Liamputtong, P. (2010). Culture and sex education: the acquisition of sexual knowledge for a group of Vietnamese Australian young women. //<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Ethnicity & Health, 15, // 343-364. doi: 10.1080/13557851003728264

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Thompson, S. C., Green, S. K., Stirling, E. J., & James, R. (2007). An analysis of reporting of sexually transmissible infections in indigenous Australians in mainstream Australian newspapers. //Sexual Health, 4,// (9-16). doi: 10.1071/SH06010

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Willis, J. (2003). Condoms are for whitefellas: Barriers to Pitjantjatjara men's use of safe sex technologies. //<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Culture, Health & Sexuality, 5, // (203-217). doi: 10.1080/136910501110614

=Responses/Reflections=

On: 'Dial up the residue, Now I’m nuts, just like a blue cashew' - Is this how we have come to view mental health in 2011???
Title: Interesting read Comments: //It's very interesting that in that particular article by Putman that the nursing and social work fields were least willing to welcome those with mental health issues into their own ranks.//

//I read through the lyrics to the song by Zebrahead and it's hard to actually identify any sort of cohesive message or statement they're trying to make. I agree that the song seems to just be 'taking the mickey' for the sake of writing a pleasing lyric.//

On: Baby Boomers to Baby Consumers. Generation Y.
Title: Great artefact Comments: //That artefact is awesome!// //Predictions such as Gen Y not exceeding their parents' financial succcess are always interesting: in the chase of the almighty dollar have we become our own undoing?//