At an educational gathering in Santa Ana, a lesson in proper condom use is about to begin, and – warning – this is no place for the prudish, the fainthearted or persons lacking a sense of humor. Teacher Frances Torres begins to pull male appendage facsimiles from her bag, plopping them on the table before her students, ages 13 to 18.
Torres has a relaxed, maternal manner well suited for the class underway. She is certified in teaching young people about sexual health and has worked in numerous schools and even women’s prisons. At this moment she’s leading a seven-week program called Cuidate, which roughly translates from Spanish into “Take care of yourself.” Teens here are first-time juvenile offenders, largely Latino.
Tonight’s assignment is for the students to work in groups to put a condom on properly, following 14 easy and not-so-easy steps. Torres passes out the model genitalia, one to each group of students, along with a condom. Torres’ teaching partner, Susana Espinoza, reminds students that the point is not to encourage them to have sex but to ensure that they do it responsibly if they choose to.
And now it’s on to the 14 steps, starting with making sure the condom is latex and checking the expiration date on the package. The more challenging part is, of course, the later steps.
One group manages to unroll the condom in the wrong direction, prompting it to roll back up and fall off.
“I just put it on backwards,” one youth says dejectedly. “She’s pregnant.”
Torres coaches him to try again, offering instruction in the neutral tone a teacher might use to correct a mistake in a math problem.
Keeping sexual topics matter-of-fact – rather than embarrassing or sordid – seems to be key to the approach at Cuidate, which is a program of the nonprofit organization Project Youth. The goal is to teach teens to prevent sexually transmitted infections (STIs) and unplanned pregnancy while taking into account Latin-American cultural norms.
Disproportionate STI Rates in Santa Ana
STIs (also known as STDs) are surging nationwide to unprecedented highs where they once were at record lows. Half of new cases are among young people, with disproportionate concentrations among minority youth. Santa Ana’s Latino youth population is no exception.
In Santa Ana, the rate (though not the number) of gonorrhea, chlamydia and syphilis diagnoses among 15-19-year-olds in 2016 was considerably higher than for this age group across the county.
Rate of diagnoses, 15-19-year-olds, 2016:
Male and female combined Orange County average Santa Ana
Gonorrhea 125 per 100,000 198 per 100,000
Chlamydia 973 per 100,000 1,572 per 100,000
Source: Orange County Health Care Agency
Why the discrepancies?
Lower-income communities generally have less access to medical care and less information and education about sexual health.
“You expect high STD rates in urban areas, in poverty and lower educational levels,” said Dr. Christopher Ried, medical director for HIV/STD Services of the Orange County Health Care Agency. “It didn’t surprise me that Santa Ana’s rates were higher than the county.”
Another troubling measure is the California Adolescent Sexual Health Needs Index or CASHNI, which targets geographical districts that need more sexual health resources based on traits such as teen birth and STI rates, poverty and other factors.
The 2016 CASHNI score for central Santa Ana is the highest in the county, followed by south Santa Ana and central Anaheim, though these scores were lower than their counterparts in the south Central Valley.
Undetected sexually transmitted infections don’t always cause immediate distress but if left untreated can be dangerous. Chlamydia can cause infertility, HIV can lead to AIDS and syphilis can result in severe birth defects.
Teen pregnancy hits urban Latina teens disproportionately as well. While adolescent births have declined in Orange County since 2004, the vast majority in the OC are to Hispanic mothers.
Resources and Culture
Income and resources aren’t the only reasons for higher rates of STD; culture also plays a part, and Cuidate addresses this issue head on, asking students to consider their cultural influences in new ways.
For example, family and respect for parents are a big part of Latino life, and Cuidate teachers use this value to get students thinking about how hard it would be on their parents if they had to take responsibility for a child’s unplanned pregnancy.
“Family is a beautiful thing in the Latino world – family first,” said Nazley Restrepo, who oversees Cuidate. “But then do I really want to do this to my parents?”
Further, Cuidate teachers Torres and Espinoza work to expand the meaning of clichéd cultural perceptions; for example, defining machismo behavior as a male protecting his partner from disease or unplanned pregnancy – rather than being domineering or what students call a “player.”
Another focus of Cuidate is what Restrepo calls “negotiation skills,” which are important for young women who lack the confidence to ask their partner to use a condom.
One of the class’s more outspoken students on this matter was Sarah, 18, who is biracially white and Latina. In class she defended the right of a female to carry a condom in her purse, even as one young man in the class said that doing so reflects poorly on a girl.
After class ended, Sarah confided that she was only 130 days out of rehabilitation for meth addiction. Drug use led her to have multiple sexual partners over the years, and she feels grateful that she didn’t get pregnant or contract an STI.
In those days, “Even if he wanted to use a condom I said, ‘No, you don’t have to’ because I was afraid I would lose the guy,” she said. “Now that I’m sober I’m realizing I shouldn’t lower myself for anyone.” She is learning how to approach relationships more slowly.
Meanwhile, she has found the Cuidate classes informative and like many other students interviewed, said they imparted information that was new to them.
Cuidate isn’t the only outreach effort in Orange County. RADAR, an organization focusing on the health needs of Latino men in Orange County, does free HIV testing outside of LGBT clubs and at social events such as drag shows.
“The stats are jarring,” said Manny Muro of RADAR. “One in four Latino men who have sex with men will contract HIV in their lifetime. That’s why I got into this work. I’m a gay Latino man and it’s affecting my community at an increased rate.”
Planned Parenthood of Orange and San Bernardino counties and AltaMed Health Services also provide bilingual presenters on sexual health to OC community centers and schools.
All state schools are required to implement a program of comprehensive, medically accurate lessons in sexual health as a result of the California Healthy Youth Act or CHYA, which passed last year.
CHYA teaches the benefits of abstinence but is not an abstinence-only program, focusing more on sexual health strategies such as STI and pregnancy prevention as well as HIV, LGBT, transgender, domestic violence and human trafficking issues.
Districts in Orange County are complying with CHYA in different ways.
Anaheim school officials revived health class for middle-schoolers and invested in CHYA-compliant curricula. Credentialed health teachers were trained in the new program and can bring in outside speakers to supplement lessons.
Santa Ana schools have fully implemented the new law, using a CHYA-driven curriculum that is taught by high school biology teachers who were trained in it. Students usually take biology in the 9th grade and need it to graduate.
But Santa Ana wants to get an earlier start.
“We will be expanding it next school year to 7th-graders,” said Deidra Powell, communications officer at Santa Ana Unified School District. “We need to get them early and educate them before they make poor decisions.”
Amy DePaul is community health editor at Voice of OC. She can be reached at firstname.lastname@example.org.