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Components of a Comprehensive Prevention Program:
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Advancing HIV Prevention Initiative:
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Evidence-Based Interventions:
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Introduction to Storytelling as a Prevention Strategy:
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“When successful, the ceremony both creates a context in which change can occur and metaphorically marks the change.”
Symbol, Story, and Ceremony
Ceremony and rites of passage have always been an important part of any culture. Universal ceremonies observe births, puberty, marriages, and death. While each culture carries out its ceremonies in a unique way, all cultures aim to transition an individual or group from one stage to the next. Puberty ceremonies, for example, transition individuals from childhood to adulthood. Ceremony can be a potent tool in addressing HIV/AIDS.
Healing Ceremonies
The Medicine Wheel is a traditional view of wellness in many Native communities. (While not all tribes use this specific representation, many have a sacred symbol for wellness.) The Medicine Wheel emphasizes the link between the mental, physical, emotional, and spiritual components of the individual. Your HIV/AIDS prevention program can benefit from this holistic approach. Medicine people traditionally used ceremony to address all aspects of a person, including the soul or spirit that is often neglected in Eurocentric healing. Eduardo Duran, Ph.D., Native psychologist and expert on post-colonial psychology, explores traditional approaches to healing. He emphasizes the importance of addressing “soul wounds.”
It can be challenging to carry out a program that meets the spiritual needs of your clients. If your program is based on a reservation, you probably have better access to healers and medicine people; however, you might lack comprehensive services or anonymity. If your program is urban, you must find a way to provide appropriate healing ceremonies for your clients. One method is to return clients to their tribal areas for ceremony; another is to bring healers to urban areas or retreat settings to conduct ceremony. Whether your HIV/AIDS prevention program is rural or urban, you are encouraged to identify cultural advisers in the community to provide support and counsel regarding spiritual issues and ceremony.
CASE IN POINT:
While working with a group of Native adolescent males in a substance abuse treatment setting, evaluator Deborah Scott, MPH, partnered with a cultural counsel. Together they designed an exercise to promote and honor the young men’s positive changes. Participants made a list of the “roles or labels” they felt they carried; the labels included how the young men saw themselves and how they felt others saw them. The young men listed roles such as alcoholic, drug dealer, brother, athlete, artist, son, and thief, to name a few. They wrote the roles on slips of paper and then divided them into two piles: those that were barriers to wellness and those that supported wellness. Next, they divided the barriers into two groups: those that were ready for release and those that were not. The young men kept the labels that supported their wellness in a place where they could access them when they needed strength. The barriers to wellness were taken outdoors. The group gathered in a circle. The cultural leader smudged the labels to be released to the Creator. The counselor offered a song while the young men ceremonially burned the labels. The young men shared their thoughts in the circle and expressed gratitude to someone in their life who cared about them unconditionally.
This is an example of an untraditional ceremony that uses cultural practices—song, smudge, and a talking story—to honor positive behavioral changes
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“Don’t be satisfied with stories, how things have gone with others. Unfold your own myth.” –Rumi
Each life story is a hero-heroine story, although few people recognize their own as such. Sharing one’s story can provide healing, insight, and inspiration to both the storyteller and the audience. Storytelling helps a person to make sense of his/her life. Sharing one’s story in a ceremonial setting—such as a sacred sweat lodge or a Talking Circle—can add ritual and community to the experience. A skilled facilitator can help participants understand the stages of hero-heroine stories and assist clients in applying the stages to their own lives. Programs can also use these stories to develop a speaker’s bureau, brochures, and other outreach material.
Personal Stories
Personal stories can also be told within the context of support groups (HIV+, Red Road, twelve-step, etc.) where thoughts, feelings, and approaches to dealing with common issues are shared. Support groups often have the additional benefit of having established norms which foster safety for participants to share. Issues of confidentiality and safety must be addressed in developing activities that include sharing of personal stories.
PERSONAL STORY: LISA TIGER
Lisa Tiger—a member of the Muscogee Nation, with Creek, Seminole, and Cherokee heritage—has raised national awareness about HIV/AIDS by sharing her personal story. In 1992, at age 29, Lisa tested positive for HIV. Since then, she has committed herself to preventing the spread of HIV among Native people. She speaks to Native Americans about HIV and ways to prevent getting infected. She travels the country and lectures to high schools students about the risks of unprotected sex. She shares her personal mission in the documentary, “The Lisa Tiger Story: If It Can Happen to Me, It Can Happen to You.” (You can order the video here.) With the help of NNAAPC, Nez Perce’s youth group—Students for Success—is currently working on its own youth-focused documentary of Lisa’s story.
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Role Model Stories
Role model stories feature individuals that share common characteristics with their audience. In HIV prevention work, role model stories explain how and why an individual (or role model) took steps to reduce risk behavior and make positive changes in his/her life. These types of stories have proven successful in prevention efforts. Some of the most powerful role model stories include the universal themes of vision, loss, struggle, helpers, and new vision.
CASE IN POINT:
The Alaska Native Tribal Health Consortium uses role model stories as part of its HIV/AIDS prevention work. ANTHC developed public service announcements featuring elders as spokespersons. The message of the elders drew on the historic experience of previous epidemics that affected Alaskan Natives and encouraged people to get tested for HIV.
CASE IN POINT:
In 2001 an Inupiaq man from a remote Alaskan village was diagnosed with HIV. He was initially devastated, as were his siblings with whom he shared the news. Their first response was to find medical care for him. However, after a time they began to reflect on the values that their deceased parents had instilled in them as children. Those values included humility, respect for others, love for children, avoidance of conflict, the role of the family, and responsibility to the tribe. Out of consideration for their ancestors and these values, the family chose to go public and educate their village and other Alaska Natives about HIV and AIDS. They took a courageous risk that has benefited many. As a result of the family sharing their story, there have been a series of community education tours to remote villages sponsored by ANTHC and NNAAPC.
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