A Latina researcher found an effective way to increase condom use among women living in farmworker communities in Florida — an important step in reducing the risks of acquiring HIV among a vulnerable community with less access to health care.

The approach? No nonsense and pretty direct.

“Many of them were ashamed to see themselves in the mirror — if they don’t know what a normal vagina looks like, how do they know if something is wrong?" said Patria Rojas, principal investigator of the study and an assistant professor at Florida International University’s Robert Stempel College of Public Health and Social Work.

So part of the homework was for the women, who are mostly Latina immigrants, to examine their own bodies. Rojas also spoke to the women about HIV, explained what it is and how it’s transmitted. As homework, the women had to practice using a female condom, which can be placed in the body hours before intercourse, giving the woman more control over safer sex.

Health researcher Patria Rojas, PhD leads a SEPA class focused on HIV prevention in Homestead, Fla. Courtesy Patria Rojas

At the end of the study, women in general were three times more likely to use condoms, while single women were four times more likely to use them.

According to the study, condom use went from 19 percent to 33 percent among sexually active women between the ages of 18 and 50.

Rojas’ study, conducted under FIU’s Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, called Crusada, focused on Latina women in rural communities of the Homestead area in Florida where there are fewer resources.

“I did this study because these women are at higher risk than women who have more education, live in communities where there is less HIV, and more access to treatment and health care,” Rojas said.

Of the 40,324 HIV diagnoses in the U.S. in 2016, around 1,277 were Hispanic women, according to the CDC.

The study evaluated the efficacy of a CDC evidenced-based and culturally tailored intervention called SEPA. The word means "know" in Spanish, but it's also the Spanish-language acronym for health, education, prevention and self-care (salud, educación, prevención y autocuidado).

Sex as a taboo subject

Apart from socio-economic issues, there are cultural factors that can contribute to making some Latinas more vulnerable to contracting HIV or other sexually transmitted diseases. There is still the belief in some households that women should not speak with their partner about sex. Researchers describe this as part of "marianismo" (from the Virgin Mary) — the belief that women should be virtuous and pure compared to “machismo,” where men can be more sexual and assertive and be the ones to make decisions about practicing — or not practicing — safe sex, according to Rojas.

Coaxing women from these rural communities to participate in the study was not easy, since talking about sex is taboo for many of them. Rojas enlisted the help of organizations and members of the community who convinced women to take part.

”Some of them have kids, but they did not know how they got pregnant,” said Rojas, explaining the limited knowledge some of the women had about human sexuality and reproduction.

Margarita Hernández, 52, participated in previous studies and is now helping Rojas to urge women to participate in the SEPA intervention.

“It’s difficult to convince them because many of them don’t feel free," Hernández said. "They have their husbands on their case," adding that many husbands don't feel comfortable or want their wives to know more about sex.

A SEPA class focused on health and HIV prevention, in Homestead, Fla. Courtesy Patria Rojas

What ends up happening, said Hernández, is that many women who say they will attend the meetings don’t show up.

Her daughter, Alicia Hernández, 33, who is a kindergarten teacher, said she learned a lot from the classes. Growing up, her mother was shy about speaking to her about sex, Hernández said.

In sixth grade, Hernández said she received a paper in school for one of her parents to sign, giving consent for a sex education class. “I explained the class to my mother, but she said no, no, no — then you will learn and you will want to do it,” said the younger Hernández, who was a virgin when she got married, which she attributes to her strict upbringing.

The women noted there is still shyness in the community, saying there are many people who need information or get the information wrong.

Like other studies, Rojas said, there is a correlation between higher education and condom use. Many of the immigrants who participated in her study also come from rural communities in their home countries where the culture and resources are different than in big cities. In some cases, some immigrants who have come to work in the Florida farms don't speak Spanish or English but indigenous languages.

One of the positive results of the educational sessions, Rojas said, is that women went back to their communities and taught other women how to use a female condom and the importance of protecting oneself from HIV or other sexually transmitted diseases.

“It was significant,” Rojas said. “I was amazed at how these women — and many of them have low academic attainment — were perceptive and how they learned.”

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