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Teaching about safer-sex Ense[+ or -]ando el Sexo Seguro in English and en espa[+ or -]ol.

The history of AIDS education takes us back to the 1980s, the decade when the world first learned about HIV and AIDS. First described as pneumocystis pneumonia (1) in 1981, the public came to erroneously understand AIDS as a disease that affected only (or mostly) gay men. There were 108 reported cases of AIDS in the United States that year, 1,641 two years later, and 10,000 in 1985. (2) By the end of the decade, more than a million Americans were infected with HIV. (3)

Early education efforts focused on the biochemistry of the disease. Classes taught people everything they needed to know about t-cells, retroviruses, and the like. Students became scholars in epidemiology, but learned little about prevention. If time was spent discussing decision-making about intercourse, or how to use condoms, it was almost as an afterthought to the main lecture.

A NEW APPROACH

At the very end of the decade, Planned Parenthood of Bergen County (4) published the first edition of Teaching Safer Sex. (5) The manual represented a new approach, shifting the emphasis from medical education to practical, interactive lessons that would help people learn and talk about prevention of AIDS.

In the introduction, the authors stated, "In an age of AIDS, 'safer sex' must become the norm. We define 'safer sex' broadly as behavior that reduces the risk of any unwanted consequences of sexual activity." (6)

Twenty lessons were assembled with nary a word on the epidemiology of AIDS. The new lessons emphasized the attitudes, values, and behaviors people needed to explore in order to reduce their risk. (7) Some of the educational concepts and principles employed in the first edition of Teaching Safer Sex, like actively engaging participants in their learning about safer sex, are now considered standard in all prevention efforts.

In 1998, Peggy Brick authored a new edition of Teaching Safer Sex. Responding to concerns raised by the Institute of Medicine (8) that HIV prevention was the only focus of safer-sex education, The New Teaching Safer Sex (9) reminded educators and young people not to forget about the many other bacteria, fungi, parasites, and viruses that cause even more cases of sexually transmitted infections each year. (It also reminded them to address the benefits of condoms in preventing unplanned pregnancy.) The new edition integrated the Transtheoretical Model of Behavior Change (10) and added new and expanded lessons. For example, it included many variations that sprung from "Don't Pass It Along." a lesson that appeared in the original manual. (11)

TEACHING SAFER SEX IN SPANISH

Earlier this year, in an attempt to reach a new audience with the popular lessons of Teaching Safer Sex, Planned Parenthood of Greater Northern New Jersey (PPGNNJ) teamed with Fundacion Mexicana Para La Planeacion Familiar (MexFam) to produce El Nuevo Eusenando el Sexo Seguro. (12) Funded by teenwire.com, Planned Parenthood's educational web site for teens (available in English and in Spanish), the new manual continues to actively engage young people, allowing them to focus on the knowledge, attitudes, and skills needed to practice safer sex but this time in Spanish. The lessons were updated to reflect current research about sexually transmitted infections and prevention, and new information about contraception. It was carefully reviewed by prominent sexuality educators of different Spanish nationalities to ensure that the manual's messages would translate across a spectrum of Latinos in the United States and abroad. On reviewing Ense[+ or -]ando el Sexo Seguro, Elizabeth Amaya Fernandez, Director of Youth Initiatives for the National Latina Health Network commented,
 At last, the best safer sex strategies and lessons in Spanish! The
 user-friendly materials in this manual are fun, relevant, and
 adaptable to diverse Latino communities.


The translation of the manual brought numerous cross-cultural challenges. Idiomatic language that is often taken for granted in English lacked its intended impact when translated into Spanish. For example, the lesson "Talk is a Four-Letter Word: Use It!" made no sense in Spanish, where "talk" is most often a six-letter word (depending on its conjugation). It was necessary to retitle this lesson "The Importance of Communication" to accurately convey the lesson's purpose. Similar challenges arose in all the lessons, as we struggled to ensure they maintained the originally intended meaning and impact cross-culturally.

The manual was distributed to hundreds of sexuality educators via SIECUS' National Network of Sexuality Educators of Color, the National Latina Health Network, and MexFam. In late 2003, we began training bilingual sexuality educators to use the lessons of the manual.

THE CONDOM LINEUP

The "Condom Lineup" activity is part of the popular "Condom Comfort" lesson. It appears in English and Spanish as taken from The New Teaching Safer Sex and El Nuevo Ense[+ or -]ando el Sexo Seguro. Over the years, the activity has become one of the fundamental methods of teaching people the steps necessary to use a condom. In the activity, participants receive a card that describes one of the steps for using a condom (e.g., roll condom on, leave room at the tip, etc.), and line up in the correct order, as other participants observe and discuss their placement. The lesson is helpful for teaching participants to reduce their user error, thereby lessening the gap between perfect use (98%) and typical use (85%) rates of effectiveness. (13)

Educators across the country and overseas commented on their experiences using the now famous "Condom Lineup."

We use an extended list--from "twinkle in the eye" to "the last goodbye." We also ask participants to think about what might really happen rather than what should happen, and then to remove those cards. Then we have an opportunity to create situations and skills that improve the situation.

Drue Brenner

Planned Parenthood of South Central New York

We use the condom lineup as a game that parents and teens play together, to de-sensitize them to talking about condom use. Parents have reported that it's a less anxiety-provoking way to discuss condom use.

Karen Eastman, PhD

UCLA/RAND Center for Adolescent Health Promotion

I often have students do the activity without talking to demonstrate how difficult managing your sexuality can be without communication.

Melissa Meyer, LPN

Planned Parenthood Cincinnati Region

CONTACT INFORMATION (INFORMACION DE CONTACTO):

Bill Taverner, Director of the (Director del) Center for Family Life Education or CFLE), PPGNNJ, 196 Speedwell Avenue, Morristown, NJ 07960. Telephone (Telefono): 973/539-9580, extension (extension) 135.

Lizbeth Cruz, Sexual Health Educator (Educadora de salud sexual), CFLE, PPGNNJ, 1150 Dickinson Street, Second Floor, Elizabeth, NJ 07207. Telephone (Telefono): 908/353-6701.

Jescenia Oviedo, Sexual Health Educator (Educadora de salud sexual), CFLE, PPGNNJ, 129 Park Avenue, Plainfield, NJ 07060. Telephone (Telefono): 908-756-3765, extension (extension) 30.

1. The Centers for Disease Control, "Pneumocystis Pneumonia--Los Angeles," Morbidity and Mortality Weekly Report 30 (1981), 250-52.

2. National Institutes of Health, "In Their Own Words ... NIH Researchers Recall the Early Years of AIDS," 2001. Accessed at (acceso conseguido en) http://aidshistory.nih.gov on October 31, 2003 (en el 31 de octubre, 2003).

3. Ibid.

4. Planned Parenthood of Bergen County later joined with two other New Jersey Planned Parenthood affiliates to form today's Planned Parenthood of Greater Northern New Jersey. (M[sz]s luego Planned Parenthood de Bergen County se uni con dos otras afiliaciones de Planned Parenthood de Nueva Jersey, para formar el Planned Parenthood de Greater Northern New Jersey de hoy.)

5. P. Brick, et al., Teaching Safer Sex. (Hackensack, NJ: Planned Parenthood of Bergen County, 1989).

6. Ibid.

7. Ibid.

8. Institute of Medicine, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, (Washington. D.C.: National Academy Press, 1997).

9. P. Brick, et al., The NEW Teaching Safer Sex. (Morristown, NJ: Planned Parenthood of Greater Northern New Jersey, 1998).

10. Prochaska, et, al., "In Search of How People Change: Applications to Addictive Behaviors." American Psychologist 47, 1102-1114.

11. "Don't Pass It Along" lessons are very interactive and demonstrate how quickly a sexually transmitted infection can spread among a group of people, even with just one "infected" participant. (Las lecciones de "No la Pases" son muy interactivas y demuestran que r[sz]pido una infecci n de transmissi n sexual se puede esparcir entre un grupo de personas, aon con s lo un participante infectado.)

12. P. Brick, with translations by (traducido por) A. Balina Valiente, El Nuevo Ense[+ or -]ando el Sexo Seguro. (Morristown, NJ: Planned Parenthood of Greater Northern New Jersey, 2003).

13. R.A. Hatcher. A Pocket Guide to Managing Contraception. (Dawsonville, GA: The Bridging the Gap Foundation, 2003).

La historia de la educaci n sobre el SIDA comenz en la decada de los a[+ or -]os 80, cuando el mundo se enter por primera vez del VIH y el SIDA. Inicialmente descrito como neumonia por Pneumocystis (1) en 1981, el poblico equivocadamente supuso que el SIDA era una enfermedad que solamente (o en gran parte) afectaba a los hombres homosexuales. En ese a[+ or -]o se informaron 108 casos de SIDA en los Estados Unidos, 1,641 dos a[+ or -]os m[sz]s tarde y 10,000 en 1985 (2). Al final de la decada, m[sz]s de un mill n de estadounidenses estaban infectados con el VIH (3).

Los primeros esfuerzos para la educaci n sobre este tema se enfocaron en los aspectos bioquimicos de la enfermedad. Se impartian clases que ense[+ or -]aban sobre las celulas T, los retrovirus y otros aspectos cientificos. Los/as estudiantes se hicieron eruditos en epidemiologia, pero aprendieron poco sobre la prevenci n. Cuando se dedic tiempo para hablar acerca de la toma de decisiones respecto a las relaciones sexuales, o c mo ponerse un cond n, se presentaron estos temas casi como anecd ticos a la lecci n principal.

UN NUEVO MODO DE ENSEOANZA

Al final de la decada, la organizaci n Planned Parenthood of Bergen County public en ingles la primera edici n del manual Teaching Safer Sex (5). Este manual representaba un nuevo enfoque que cambi el enfasis en la educaci n medica hacia lecciones pr[sz]cticas e interactivas que ayudarian a la poblaci n a aprender y hablar acerca de la prevenci n del SIDA.

En la introducci n, los/as autores indicaron que: "En estos tiempos de SIDA, las 'pr[sz]cticas sexuales seguras' tienen que ser la norma. Definimos 'pr[sz]cticas sexuales seguras' en general como los comportamientos que reducen el riesgo de cualquier consecuencia no deseada al tener relaciones sexuales" (6).

Se elaboraron veinte lecciones con pocas palabras relacionadas con la epidemiologia del SIDA. Las nuevas lecciones pusieron enfasis en explorar las actitudes, los valores y los comportamientos que las personas necesitaban seguir para reducir su riesgo (7). Algunos de los conceptos y principios incluidos en la primera edici n de Teaching Safer Sex son considerados ahora est[sz]ndares en todos los esfuerzos de prevenci n, por ejemplo, hacer que los/as participantes contribuyan activamente en el aprendizaje sobre las pr[sz]cticas sexuales seguras.

En 1998, Peggy Brick escribi una nueva edici n de Teaching Safer Sex como respuesta a las inquietudes expresadas por el Institute of Medicine (8) respecto a que el onico enfoque de la educaci n para las pr[sz]cticas sexuales m[sz]s seguras era la prevenci n del VIH. El manual The New Teaching Safer Sex (9) les record a los/as educadores y a los/as j venes no olvidarse de las muchas otras bacterias, hongos, par[sz]sitos y virus causantes de un nomero todavia mayor de casos al a[+ or -]o de infecciones de transmisi n sexual. (Y tambien trat el tema de los beneficios del cond n en la prevenci n del embarazo imprevisto). La nueva edici n integr el Transtheoretical Model of Behavior Change (10) y agreg lecciones nuevas y ampliadas. Por ejemplo, se incluian muchas variantes derivadas de una lecci n que aparecia en el manual original, titulado Don't Pass It Along (11).

COMO ENSEOAR LAS PRACTICAS SEXUALES MAS SEGURAS EN ESPAOOL

Al principio de este a[+ or -]o, en un esfuerzo por llegar a una audiencia nueva con las lecciones populares de Teaching Safer Sex, Planned Parenthood of Greater Northern New Jersey o PPGNNJ colabor con la Fundaci n Mexicana para la Planeaci n Familiar (MexFam) en la producci n en espa[+ or -]ol de El Nuevo Ense[+ or -]ando el Sexo Seguro (12). Financiado por teenwire.com, el sitio web de Planned Parenthood para j venes (disponible en ingles y en espa[+ or -]ol), el nuevo manual continoa involucrando activamente a los/as j venes, permitiendoles que se enfoquen en el conocimiento, las actitudes y las habilidades necesarias para realizar las pr[sz]cticas sexuales m[sz]s seguras, pero esta vez en espa[+ or -]ol. Las lecciones se revisaron para reflejar las investigaciones corrientes acerca de las infecciones de transmisi n sexual y su prevenci n, asi como nueva informaci n sobre los anticonceptivos. Fue revisado con cuidado por prominentes educadores de la sexualidad de diferentes nacionalidades hispanoparlantes para asegurar que los mensajes del manual pudieran transmitirse a un amplio espectro de latinos en los Estados Unidos y en otros paises. Al revisar Ense[+ or -]ando el Sexo Seguro, Elizabeth Amaya Fern[sz]ndez, la Directora de Youth Initiatives para la National Latina Health Network coment :
"!Por fin, las mejores estrategias para ense[+ or -]ar pr[sz]cticas sexuales m[sz]s
seguras con lecciones en espa[+ or -]ol! Los materiales de f[sz]cil uso de este
manual son divertidos, pertinentes y adaptables a las diversas
comunidades latinas".


Numerosos retos transculturales surgieron durante la traducci n del manual. Las expresiones idiom[sz]ticas en ingles que a menudo se dan por entendidas, carecian del impacto deseado al traducirlas al espa[+ or -]ol. Por ejemplo, la traducci n del titulo de la lecci n "Talk is a Four-Letter Word: Use It!" no mantuvo el sentido en espa[+ or -]ol porque la palabra "hablar" es realmente una palabra de seis letras y no de cuatro (sin tomar en cuenta su conjugaci n). Era necesario cambiar el titulo de esta lecci n a "La importancia de la Comunicaci n" para poder transmitir precisamente el prop sito de la lecci n. Se presentaron retos similares en todas las lecciones, mientras luchamos para asegurarnos que se conservara el significado y el impacto transcultural que originalmente estaba previsto.

El manual se distribuy a cientos de educadores de la sexualidad por medio de The National Network of Sexuality Educators of Color del Consejo de Informaci n y Educaci n de la Sexualidad de los Estados Unidos (Sexuality Information and Education Council of the United States o SIECUS), la National Latina Health Network y MexFam. A finales del 2003, empezamos a capacitar a educadores de la sexualidad bilingues para impartir las lecciones del manual.

LA ALINEACION DEL CONDON

La actividad "Alineaci n del Cond n" es parte de la popular lecci n "Comodidad del Cond n" y aparece en ingles y en espa[+ or -]ol en The New Teaching Safer Sex y El Nuevo Ense[+ or -]ando el Sexo Seguro. Al paso de los a[+ or -]os, la actividad ha llegado a ser uno de los metodos fundamentales para ense[+ or -]ar los pasos necesarios para utilizar un cond n. En la actividad, los/as participantes reciben una tarjeta que describe uno de los pasos para utilizar el cond n (por ejemplo, enrollar el cond n casi hasta la punta, dejar un espacio sin enrollar en la punta, etc.), y las van colocando en el orden correcto, mientras que otros/as participantes observan y analizan el orden de los pasos. La lecci n es otil para ense[+ or -]ar a los/as participantes a reducir errores al usar el cond n, disminuyendo la discrepancia entre los indices de eficacia del uso perfecto (98%) y del uso tipico (85%) (13).

Los/as educadores de todo el pais y del extranjero comentaron sus experiencias con la ya famosa actividad "Alineaci n del Cond n".

Utilizamos una lista grande, desde "un gui[+ or -]o del ojo" hasta "el oltimo adi s". Tambien pedimos a los participantes que piensen en lo que pudiera realmente suceder, en vez de pensar en lo que debe suceder, y entonces quitar esas tarjetas. Asi tenemos la oportunidad de crear situaciones y generar habilidades que mejoran la situaci n.

Drue Brenner

Planned Parenthood of South Central

New York

Utilizamos la alineaci n del cond n como un juego que padres y j venes juegan juntos, para romper el hielo y ayudarles a hablar acerca del uso del cond n. Los padres nos han informado que es una forma que genera menos tensi n al hablar sobre el uso del cond n.

Karen Eastman, Ph.D.

UCLA/RAND Center for Adolescent

Health Promotion

A menudo yo pido que los estudiantes hagan la actividad sin hablar para demostrar que tan dificil puede ser manejar su sexualidad sin modos de comunicaci n.

Melissa Meyer, LPN

Planned Parenthood Cincinnati Region

The New Teaching Safer Sex and El Neuvo Ensenando el Sexo Seguro are both available from the Center for Family Life Education at Planned Parenthood of Greater Northern New Jersey. In addition to The Condom Lineup lesson that appears on the following pages, these manuals also feature valuable lessons on Sexual Transmitted Diseases, HIV/AIDS, abstinence, outercourse, communication, and safer sex issue for gay, lesbian, and bisexual youth.

For more information: Center for Family Life Education, Planned Parenthood of Greater Northern New Jersey, 973/539-9580 ext. 120.

Bill Taverner, M.A., Lizbeth Cruz, and Jescenia Oviedo

The Center for Family Life Education Planned Parenthood of Greater Northern New Jersey Morristown, NJ
COPYRIGHT 2004 Sexuality Information and Education Council of the U.S., Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Oviedo, Jescenia
Publication:SIECUS Report
Geographic Code:1USA
Date:Jan 1, 2004
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