HIV Education in Disguise: Sin Verguenza (Without Shame), a soap opera for social change

June 27, 2016

Can a telenovela (soap opera) change attitudes and behaviors about HIV testing, treatment, and prevention?

Hilda Sandoval, PhD, and Natalie Sanchez, MPH, think so. They both work at AltaMed, a federally qualified health center (FQHC) in Los Angeles. In fact, AltaMed is the nation's largest FQHC. It's also the largest HIV medical provider for Latinos in Southern California. Sanchez is the Clinic Administrator of Alta Med's HIV Department, and Sandoval serves as the Mental Health manager.

They've teamed up to create Sin Vergüenza, (Without Shame) the gripping story of three generations of the Salazar family: a fictional Mexican-American family living in Los Angeles and dealing with HIV/AIDs. The seven episodes of the mini series are available for viewing in English or Spanish.  Sin Vergüenza does not air (yet) on network television. You can watch the short episodes on AltaMed's You Tube channel:  https://www.youtube.com/user/healthsvcs

Here's the English version of the first episode of Season 1. It's just under 8 minutes:

Sandoval and Sanchez were among the featured presenters at the 2016 National Latino HIV/Hepatitis C Conference (June 6-8), held in South Padre Island, Texas. Valley Aids Council (VAC) hosted the conference with its partner organization, Westbrook Clinic. A Ryan White-funded agency, VAC has been providing medical care and related services for people living with HIV along the US/Mexico border since 1987.

Latinos are disproportionately affected by HIV and hepatitis C compared to other ethnic groups and races, and according the the CDC, 7 in 10 new HIV diagnoses among Hispanics and Latinos occur in gay and bisexual men.

The goal of the conference was to bring the needs of Latinos to the forefront of local, national, and global HIV and hepatitis C treatment and prevention efforts. As we learned with the recent tragic event that occurred on Latin night at the Pulse nightclub in Orlando, discrimination and stigma persist in the United States in regard to Latinos, and especially Hispanic/Latino men who have sex with men. Conferences such as the 2016 Latino HIV/Hepatitis C Conference provide a forum to shine the light on this population and address these disparities.

A soap for social change--produced by an FQHC

Clockwise: J.M. Longoria, l-r: Hilda Sandoval, J.M. Longoria, 
and Natalie Sanchez; National Latino HIV/Hep C Conference banner. 
Photo: J.M. Longoria Instagram
The idea for the telenovela came about when AltaMed was training its employees to prepare them for universal HIV testing of all AltaMed patients.

"We used a series of training videos on a range of topics designed to make sure that AltaMed employees were well-educated and felt confident implementing HIV testing," says Sandoval. "Educating patients was just as important, but would require a different approach, and that's when we decided to create a telenovela that would be both educational and entertaining."

Adds Sanchez, "We wanted the series to factor in the cultural nuances of the Latino population, but in a way to help people get informed and counteract some of the inaccurate info presented in other telenovelas, where HIV is often depicted as fatal."

The series also counteracts the misconceptions people who are married or over 50 don't need to get tested for HIV.

The storylines are based on the real-life experiences of clients that Sanchez and Sandoval have worked with at AltaMed. Actors were chosen carefully, they say. "We wanted to make sure that we had actors who are fluent in both English and Spanish and could really do the project justice," explains Sanchez.

One of the lead actors is J.M. Longoria, who actually grew up in the Rio Grande Valley--and also attended the 2016 National Latino HIV/Hepatitis C conference.  J.M. spoke about the rewards of acting in a series that highlights top issues in the Latino and LGBT communities.

The first four episodes (Season 1) of the series launched in March 2012, with a focus on increasing HIV knowledge and understanding of risk factors. Sanchez and Sandoval worked with the Council for La Raza at Cal State Long Beach to create a viewers' survey that gathered information on whether the project was effective in changing knowledge and behaviors. Results suggest that  Season I was successful in changing views of condom use and HIV testing:

"Regarding self-efficacy intention to test for HIV, use condoms, and negotiate use with partners, findings indicate that most participants plan on engaging in HIV risk reduction behaviors." Sin Vergüenza Telenovela, AltaMed Health Services Findings 2013

The three episodes of Season 2 launched in March 2016. Season 2 continues the focus on education and understanding, particularly for people living with HIV, and also covers mother-to child transmission of HIV,  and HIV medications, including Pre-exposure Prophylaxis, or PrEP.

A viewer survey also accompanies the Season 2 episodes. Watch the series, complete the survey, and you could win a $100 gift card! 

(Spoiler alert: Keep your kleenex within reach for the final episode.)

Entertainment Education

Around the world, soap operas like the one that Sin Vergüenza is modeled after have been channels for significant social change, linked, for example, to better HIV education and condom use in Tanzania, increased adult literacy in Mexico, and changing attitudes about dowries and female education in India. These daytime (and in many parts of the world, prime time) dramas use the "Sabino Method," developed by Mexican television producer Miguel Sabido--widely considered to be the father of entertainment education.

Producing the series has been extremely rewarding, say Sanchez and Sandoval. "It's very gratifying to  hear the experiences of people who might have been impacted by Sin Vergüenza " says Sanchez. "The response we've had so far keeps us motivated for what's next as we continue to explore innovative ways to connect with our community."

Sanchez and Sandoval would like to get Sin Vergüenza  to network TV and mainstream audiences. They're seeking funding for a third season to continue to enhance knowledge and understanding of HIV. They're also interested in collaboration opportunities for reaching other populations through the series. "We recognize that there are some limitations to relying on the internet to air the series and could make Sin Vergüenza available through other methods," they add. "Our main goal is to address the high level of HIV infections in our communities and to find ways to reduce it."

For more information about Sin Vergüenza, contact:
Hilda Sandoval: hsandoval@la.altamed.org
Natalie Sanchez: Nsanchez@la.altamed.org

Related resources from the ATTC Network

The National Hispanic and Latino ATTC offers a variety of trainings, webinars, and fact sheets on HIV and Hepatitis C. For example:
The ATTC's YMSM+LGBT Center of Excellence offers monthly webinars and a training curricula to help providers deliver culturally responsive and evidence-based prevention and treatment services for lesbian, gay, bisexual, and transgender populations dealing with co-ocurring substance use and mental health disorders.  


The ATTC Network also offers
  • HCVCurrent: a face-to-face training or online course. Coming soon: SBIRT for hepatitis C video vignette series! 
  • Substance use disorders in Minority Men who Have Sex with Men: an online course available through the ATTC Network's online learning portal, HealtheKnowledge 

Related blog posts:
Linking Hispanics and Latinos to Health Care: Promotora Programs





Are we leveraging digital technology in addiction treatment?

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David H. Gustafson
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The Center for Health Enhancement at the University of Wisconsin-Madison developed A-CHESS, a smartphone app for recovery support, based in part on ideas that emerged from experts in diverse fields and people suffering from addiction or affected by it. In 2009, in a Behavioral Healthcare article, I talked about key ingredients that a technology-based addiction treatment systems such as A-CHESS would need.

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Thomas F. Hilton, PhD

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You could call this style "leading by telling."

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Leading by telling risks creating a disempowering work climate, one that can lead lead to "satisficing": doing exactly what one is told, sufficient to satisfy the boss. No more, no less.

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Executive Director, Clayton Behavioral, St. Louis, Missouri
Adjunct Professor, Washington University



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What's New This Week in the ATTC Network


May 24, 2016

Maureen Fitzgerald
ATTC Network Coordinating Office

The ATTC Network brings the addiction treatment and recovery services field a range of new publications, webinars, and training resources each week. This week, for example, brings you a new resource on integrating substance use disorder treatment with other health care, a webinar on teen use of e-cigarettes, vaping, and dipping, and easier access to ATTC bilingual resources.

Myth buster: Change Takes Time. A Lot of Time.

May 16, 2016

Thomas F. Hilton, PhD

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But I'm here today to bust the myth that change takes time.

Hepatitis Awareness Month and Hepatitis Testing Day


Holly Hagle, PhD
Director
National SBIRT ATTC

Leslie Cohen, BS
Director
New England ATTC

May 10, 2016

The month of May is designated as Hepatitis Awareness Month in the United States, and May 19 is Hepatitis Testing Day. During May, many public health partners will work to shed light on this hidden epidemic by raising awareness of viral hepatitis and encouraging priority populations to get tested (CDC, 2016).

See the May 2016 press release from the CDC: Hepatitis C Kills More Americans than Any Other Infectious Disease