Gay Male Culture, Hispanic Culture, Gay Male and AIDS: Counseling Implications

ALEX CARBALLO-DIÉGUEZ

The AIDS epidemic is affecting Hispanics in disproportionately high numbers. High-risk sexual behavior conducive to HIV infection seems to continue taking place among Hispanic gay men. This article presents some necessary considerations when counseling this population.

he epidemic of Acquired Immune Deficiency Syndrome (AIDS) is affecting Hispanics in disproportionately high

reported that the national cumulative incidence (number of cases per million of the population) of AIDS is 2.6 Hispanics to 1 White Anglo American (WAA). Bakeman, McCray, Lumb, Jackson, and Whitley (1987) reported that, excluding intravenous drug users, the national cumulative incidence of AIDS for Hispanics is 1.7 to 1 WAA. Even more worrisome is the fact that the rate of rectal gonorrhea of homosexual/bisexual Hispanic men has not shown the decline it has shown among homosexual/bisexual WAA attending sexually transmitted disease clinics in New York and San Francisco in recent years (New York City AIDS Task Force, 1988). This seems to indicate that there is no reduction in high-risk sexual activity among gay Hispanic men and that sexual HIV transmission may be continuing at a substantial rate.

It is important, therefore, to maximize the efficiency of interventions directed toward gay Hispanic men to help them modify risk behavior. This article presents some necessary considerations when counseling gay Hispanic men about AIDS.

LANGUAGE

The obvious initial step to an effective communication is to code the message in a language understandable to the listener. This task is far from being as simple as it sounds. Hispanics living in the United States have different levels of proficiency, both in English and in Spanish. Some Hispanics are new immigrants who hardly manage a few words in English. Others are secondor third-generation Hispanics born in this country who are unable to speak Spanish but who do, nevertheless, identify with Hispanic cultural values. Between these two extremes there are different levels of bilingualism. Some Hispanics master both English and Spanish artfully. Others speak Spanglish (Malgady, Rogler, & Costantino, 1987), a mixture of both languages used by people who borrow words from one or the other language but who are unable to speak either one correctly. Spanglish has produced frequently heard hybrid constructions such as rufo (English word roof + last vowel of techo, which is Spanish for roof) or liquea (English to leak and Spanish conjugation of verb gotear, to leak). Therefore, a careful study of language dominance of the listener is necessary before choosing the language vehicle for an intervention.

Another level of difficulty occurs when we consider the different national origin of Hispanics. Rather than being a homogeneous group, Hispanics are natives from the Caribbean and Central and South America (people from Spain are generally referred to as Spaniards rather than as Hispanics). Each national group uses a certain variation of Spanish with local meanings and characteristics. For example, no te apures means don't hurry in Argentina and don't get annoyed in Puerto Rico. Me da coraje means it makes me angry in Puerto Rico, whereas it translates as it gives me courage when used by an Argentine. Because all are accepted meanings for the same words, we need to know the regional uses to ensure the significance of our message.

When we consider slang, we add a further twist to the matter. Slang is formed by idiosyncratically used words and neologisms. We are all familiar with teenage slang. Other groups, such as gay men, also have words with special meanings understood mainly within the group. When gay men in Argentina say that someone entiende (literally understands), they mean that the person is gay. Puerto Ricans call gay men patos (literally ducks). Conversely, Spanish does not have an equivalent to our current use of the word gay, much less gay pride (Tavares, 1988). If our intervention is directed to gay Hispanic men, we need to know not only their language dominance and regional uses of the language but also the words used within their gay community that will convey the message in the most familiar way. A client who looks Hispanic and speaks Spanish fluently will not necessarily make Spanish his language of choice (Marcos, 1980), as depicted in the following case study:

Reynaldo was a young gay client who spoke English with a thick Spanish accent, rolling the "r" and restricting vowel sounds to the five types available in Spanish rather than the 13 vowel sounds of the English language. Despite his wide knowledge of Spanish vocabulary, he limited himself to a colorless colloquial English. This choice showed his attempt to try to fit with the mainstream society and also to reject his mother culture which had not accepted him as a gay person.

I generally start my first contact with clients by asking them what language they prefer to use. I pose the question both in English and in Spanish to avoid biasing the client's choice with my own and also to show the client I feel at ease in both languages. At times, clients have reported how uncomfortable it is for them to be interviewed by a professional who has a poor command of Spanish but nevertheless insists on using it.

Many fully bilingual Hispanics use English and Spanish in a peculiar way: They use the former as the main vehicle to express their thoughts, but they switch to the latter for all the emotionally charged expressions. For example, "And I told him, Dios Mio! you got to see a doctor, chico, you need help."

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Malgady et al. (1987) reported that bilinguals frequently experience a loss in second-language fluency under stressful conditions, such as in a psychiatric interview. This observation coincides with research findings that support the notion that early traumatic events are recorded in our memory in our mother tongue.

Case Study

A group of fully bilingual Hispanics was asked to respond to a word association task both in English and Spanish. The words were organized in different lists, some of which were apparently innocuous, whereas other lists contained words likely to elicit emotional responses (breast, cut, dodo). It was observed that the reaction time for these words was significantly longer in Spanish than it was in English, whereas the comparison of innocuous words showed no difference in reaction time between the two languages. These results seem to support the hypothesis that traumatic or emotionally charged concepts are encoded in the mother tongue (A. Brok, personal communication, 1985).

Similarly, a gay Hispanic client discussed in his session how he felt more hurt by being called maricón than by being called the equivalent English term, faggot. Once more, awareness of the different weights of same concepts expressed in one or the other language may enhance our understanding of the client's dynamics and add strength to our intervention.

Another language characteristic is the use of the formal or informal you. Spanish has two different forms for you, the second person singular: tú and usted. A few countries also use vos instead of tú. Tú is used when there is a familiar relationship between people, whereas usted is more formal. This usage also varies in different nations. Puerto Ricans tend to use the familiar form tú regardless of who they are addressing. Colombians use the formal usted even among family members. The choice of tú or usted, when not determined by usage in the country of origin, is a way of showing the psychological distance between the persons engaged in the conversation. A client who treats me as tú is showing a wish to feel closer to me, to abolish the distance implicit in the therapist-client relationship, maybe even a wish to identify with me as a positive role model. The use of tú may also mean an attempt of the client to manipulate me, to treat me as a chum, to discredit the professional weight of my interventions, or to seduce me. A client who chooses the formal usted may be exhibiting deference, respect, even obedience; he or she may also be showing how distant and different he or she feels from me. Therefore, the familiar or formal modality of the language chosen considered in the client-counselor interaction is an important psychodynamic indicator. This can be applied instrumentally when it comes to counseling gay Hispanic men about AIDS. For example, a counselor may chose the familiar tú in the discussion of safer sex guidelines so as to help the client feel more confident to open up and discuss his difficulties in following the advice. It can also be applied in the type of literature that is generated to educate Hispanic men about AIDS.

Another note about language has to do with jokes. Politicians use jokes to gain the approval and acceptance of the audience, and jokes can also be a powerful tool when used in counseling. Jokes have a surprise effect on the listener by bringing forward a subconscious and unexpected meaning of a word (Freud, 1905/1973). Most jokes are constructed with elements familiar to the people involved. Gay Hispanic men have their inner jokes, many of which use peculiarities of the Spanish language.

Hispanic Gay Male AIDS

For example, most adjectives in Spanish indicate the gender of the name they qualify. Thus, unlike English where both a man and a woman are tall, in Spanish a man is alto and a woman is alta. These elements can be manipulated in the language to achieve comic, although many times campy, effects when a gay Hispanic man uses the feminine ending of an adjective to refer to himself. On the other hand, translations of jokes generally lose the comic effect and hinder rather than open a path to the unconscious.

There is a note of caution: Jokes can be a double-edged sword. A joke that is used prematurely in the treatment of a client, with cultural insensitivity, or without having previously established a good rapport may be perceived as offensive and produce an antitherapeutic effect. Carefully used, however, jokes and humor in general facilitate the communication and relax the client.

The effect of poetry is also quite diminished when verses are translated. This holds true for proverbs and minor rhymes as well. A recent AIDS prevention campaign of the New York City Department of Health had the slogan "The Best Protection Is No Injection." The phrase has rhythm and equal stress in both main concepts (protection, injection). It can easily become a catchy phrase or it can be incorporated into a rap song. None of these characteristics is present in the translation, which the Department of Health used in the Spanish brochures. "La mejor protection es no injectarse" is a passionless phrase that lacks punch. The problem lies in developing the idea in one language and then in trying to translate it literally into another language. Although lip service is paid to the fact that literal translations are useless, the truth of the matter is that 90% of the information on AIDS available in Spanish is a literal translation from English.

Finally, the educational level of the listener has to be taken into account. A recent study of 16 pieces of AIDS educational material showed that the information was written on a grade 14 reading level—well above the reading level of 80% of 18to 24-year-old Hispanics (Landers, 1988).

In summary, to be effective in counseling gay Hispanic men, all these language nuances have to be taken into account. Do you want to deliver the message in English, in Spanish, or in both languages? Have you taken into account the regional variations of the language used by your audience? Do you want to use bookish language to add a sense of authority to your message, or do you prefer everyday slang and inner words of gay groups to make the message more familiar and easy to absorb by the listener? If your listener chooses one language over the other, what is the meaning of this choice? Do you want to address your client in a formal or a familiar way? Can you benefit from the special emphasis that certain words acquire in the mother tongue? Is it possible to use jokes, rhymes, or proverbs in your message? Did you consider the educational level of the receptor of the message?

There is no one general answer to these questions. Each person you are working with may require a different approach, and the intervention should be tailored accordingly.

SOCIOECONOMIC STATUS

When we try to design an intervention program for gay Hispanic men, we must take into consideration their socioeconomic level. It is well known that Hispanics in the United States have in general a lower socioeconomic status than do WAA (Alvirez, 1981). Sometimes this is because of recent immigration, language barriers, lack of skills, or poor schooling. Many other

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