XIII
Sexual Culture and Alternative Approaches to AIDS Prevention
The monolithic and self-perpetuating character of hegemonic discourses is such that religious dictates, along with gender roles and sexual orientation, are widely understood to be nonnegotiable absolutes. However, in examining processes involved in the development of gender identities and sexual orientation among adolescents, recognizing how discourses have constructed rules, norms, explanations, expectations and sexual practices has served to illustrate the differences present in hegemonic discourses and, in so doing, has challenged the indissoluble nature of “sexuality”. However, rather than overtly resisting and rewriting the discourses on sexuality, young people frequently adopt what we have termed co-existence behavior (ie. they engage in conflict-resolution strategies that do not address the root of the problem).
In Costa Rica, co-existence behavior has taken on a number of different forms in its hidden resistance to sexual discourses, in the process contributing to the difficulties inherent in AIDS prevention work among the country's adolescent population. Manifesting itself in censorship, internal watchdog mechanisms, compartmentalization, magical-religious thought, sexual and economic violence and escape mechanisms, this type of behavior seeks to redress contradictions among the dominant discourses, yet in the end only provides temporary solutions to long-term problems.
Censorship
Having defined it as an attempt to hinder the free flow of information as a means either of limiting resistance to dominant discourses, or of preventing the emergence of alternative ones, censorship is clearly one of the key barriers in the way of an effective AIDS prevention strategy in Costa Rica. Spearheaded by the Roman Catholic Church, in association with particular elements within the media and public at large, there has been a concerted attempt to censor material dealing with pre-marital sex and AIDS-related topics by staunchly opposing any moves to include the latter on the sex education curricula of the public school system. However, while this censoring may prevent an attack on dominant sexual values and mores, it also silences debate on alternatives open to young people who are sexually active or who have questions concerning their sexuality.
Interestingly, this attempt to stifle potential resistance to the dominant religious paradigm has not been extended to the romantic or gendered constructions of sexuality. Rather, the popularity (and availability) of romantic novels, films and pornography has if anything increased, perhaps because these discourses do not pose a threat to dominant modes of thought, as the messages they disseminate serve to reinforce the religious understanding of sexuality.
Nonetheless, for as long as the dominant ideology remains unquestioned, and sex education remains unavailable, young people will continue to fall prey to unwanted pregnancies and HIV infection in this country. As it stands, they are internalizing a set of values which lead them to believe that active penetration is superior to passive penetration, and that God does not punish good Christians. Of course, once such views have been assimilated, one can hardly expect adolescents to be in a position to make the choices that will allow them to lead healthy, fulfilling sexual lives.
Internal watchdog
Discipline is another means of silencing resistance and contradictions. Through this process, young people learn to police their own behavior, and thus do not have to rely on external forces to keep them 'in line'. In this way, whenever individuals engage in an activity that, upon reflection, falls beyond the bounds of respectability, their 'internal watchdog' is invoked, inducing feelings of guilt and suppressing memories of the offending act. Examples of such behavior include childhood sexual games, along with instances of homosexual contact with friends and companions of the same sex.
However, forgetting is not the only mechanism employed to protect oneself from the consequences of sexual transgression. Denial is also used in this regard, most notably by cacheros who have sexual relations with other men yet do not consider themselves gay. Of course, among the consequences of these 'internal watchdog' mechanisms is the tendency to downplay (or deny altogether) the risks associated with unsafe sex and, at a more general level, to fail to learn from one's sexual experiences. All too often, young people, having 'discovered' sexual urges within themselves, attempt to satiate these desires without having the slightest consciousness of AIDS prevention strategies or family planning methods.
Thus, instead of giving youth the tools with which to take responsibility for their actions, hegemonic forces attempt to control the latter's bodies through fear, guilt, disgust and shame. In this way, the Church, by condemning all expressions of sexuality that are not directly related to procreation, has made young people ashamed of their sex organs, and feel disgust at any 'illegitimate' sexual act, be it masturbation, cunnilingus, petting or kissing. Moreover, as the interviews and group sessions have shown, this shame is also felt when individuals go to the store to buy condoms and other birth control devices. As one might imagine, this is largely because the latter are associated either with homosexual or non-procreative sex, thereby invoking guilt and fear of punishment among the young people involved.
Magic-religious thought
In many cases, the proponents of hegemonic discourses attempt to erase contradictions by demanding that individuals engage in autos da fé, in other words that they accept discursive premises on the basis of faith alone. Mary's immaculate conception and Christ’s resurrection provide obvious instances of Christianity's magic-religious orientation. In effect, these attitudes invoke supernatural explanations for natural events, 'resolving' contradictions and tensions by placing them outside of the human realm and in that of magic-religious thought.
While every society has been influenced to some extent by its magic-religious belief system, in Costa Rica this discourse is still overwhelmingly dominant despite the existence of substantial antagonism and contradiction vis à vis other discourses. Should confirmation of this claim be required, one need only consider the fact that Costa Ricans, particularly those who are fundamentalist, widely assume that supernatural forces influence most facets of their lives. Even those who are not devout share these views, and thus it should come as no surprise that many young people believe that gods and devils are intimately involved in their decisions to have intercourse, engage in sexual violence, use condoms, watch pornography, or have multiple partners.
Of course, in adhering to such a belief system, individuals are absolved of personal responsibility for their actions. When a 'mistake' is made or the bounds of 'legitimate' behavior transgressed, the perpetrator can excuse him or herself by arguing that a supernatural being had influenced, or even made, the decision to act in a particular way. As such, if a person has sex with while in love, he or she can claim that the hand of a god lay behind this action, and thus explanations need not be sought. Similarly, in the event of rape or sexual abuse, individuals will often attempt to justify their actions by claiming that they had been swayed by the Devil. While, this is not to suggest that there is no room for autonomous decision-making, young people quickly learn that this is neither the only nor necessarily the best way to justify oneself.
With respect to personal relationships in particular, adolescents have internalized the belief that 'scientific thinking' is inappropriate for people who are in love, lest they be considered unromantic or insincere. In this way, young people are often convinced by the argument that partners should be chosen on the basis of physical attraction alone (ie. Cupid's arrow), and not because of intellectual or personal compatibility. Needless to say, such a perspective does not lend itself to frank discussion concerning the causes of AIDS and prevention strategies, since sexual intercourse is perceived to be a 'magical' space of gods and demons untouched by rational thought or common sense.
Compartmentalization
Young people also attempt to address conflicts and discrepancies in sexual discourses through a process of compartmentalization. What does this mean? Quite simply, rather than rejecting contradictory behaviors and values out of hand, they are placed in separate mental categories, where they co-exist in segregation from one another. In this way, behavior becomes dependent upon the company or situation in which one finds oneself, with individuals losing awareness of the contradictory nature of their actions.
In Costa Rican society, the roots of compartmentalization are three-fold: religion, family and historical background. In the first instance, religion encourages such behavior by demanding unswerving obedience to its precepts, leaving no space for the articulation of alternative positions or perspectives. Unorthodox ways of thinking or acting are silenced so as to avoid the risk of condemnation or punishment. Secondly, the structure of the Costa Rican family also reinforces compartmentalization through the central role it plays in young people's lives. In short, not only is it assumed that youth will live at home until married, but also that they will rely on their parents to find gainful employment. Thus, loyalty to family values is considered vital, and young people are expected to live for their families as well as themselves. Finally, the country's historical legacy is such that it was relegated to the periphery of the Spanish empire, which meant that social control mechanisms were relatively lax, leaving people free to engage in actions (eg. sex outside of marriage) that would not have been tolerated in the larger colonial centres of Mexico or Peru.
On account of this, the population has learned to live with stark contrasts between the norms expected of them on the one hand, and the reality of their day-to-day lives on the other. Costa Ricans' sexual practices confirm this view. For example, in 1995 more than 40 percent of all births took place outside of wedlock, thereby revealing monogamous marriage to be nothing more than a 'museum piece' that is admired from afar, yet rarely seen in practice (Barth 1988, p.121).
Moreover, as the number and intensity of contradictory ideas increase, so too does compartmentalization. Consequently, Costa Ricans have inherited two antagonistic and opposing currents of thought, namely asceticism and machismo. On the one hand, they have been taught that sex is a means for men to demonstrate their manliness and, on the other, a cardinal sin. However, these different spheres of life are 'disconnected' from one another by compartmentalization. That is to say, within each person the boundaries between different ideas, beliefs and behavior become reified, resulting in a situation whereby the 'religious' sphere is disconnected from 'scientific' thought; the emotional sphere is disconnected from reason (since love and reason are deemed incompatible); sexuality is separated from religion (as the latter is seen as entirely hostile towards the former); and finally, among men in particular, gender is removed from the romantic realm (since men must reject machismo's contempt for women if they are to establish a loving relationship with one).
Given this outlook, it is not surprising that young people's sexual culture is also compartmentalized. In short, even as their parents talk to them about the importance of virginity and fidelity, they look around them and see a world rife with adultery and sexual precociousness. Religious dictates are championed yet often go unfulfilled. To cope with these apparent dichotomies, adolescents have divided their environment in ways that correspond to their own mental categories. For example, bars are seen as spaces where desire and sexuality can be openly expressed. Church, meanwhile, is a place for pious behaviour, just as school is for studiousness and rational thought.
In this way, young people's compartmentalized communities correspond with their compartmentalized minds, engendering what are often radical changes in personality as they move from one locale to another. Thus, girls who are reserved and passive in Church may very well become assertive and aggressive when they are at the beach with friends. Similarly, young men who are models of good behavior at home become gang leaders or sexual predators when on the street.
That negative consequences should arise from this dichotomization of space and behaviour should be obvious. In matters of AIDS awareness in particular, young people are unlikely to benefit from education and prevention initiatives if they do not perceive there to be a link between the context in which they receive the information (ie. school or Church) and the context where it could actually prove useful (ie. in a brothel or at a party).
Sexual violence
The social construction of gender has profound implications for the nature of social relations among men and women, with violence being merely one of the ways in which individuals (usually men) cope with latent tensions and contradictions within the latter. In particular, it is used to prevent or punish behavior that calls into question patriarchal relations of power.
For Costa Rican youth, this violence has become a means of controlling and asserting ownership over women's bodies. The means through which this control is exercised vary; though in many case the violence is extreme. For example, the day after we conducted an interview with one young woman, she was raped by her boyfriend. As the school's guidance counselor made clear to us in meetings afterwards, instances of rape and non-consensual sex are all too common among the female student body.
Moreover, not only was rape reported, but so too was sexual abuse and incest, with one participant in particular admitting to having been raped and assaulted by her own father. Others stated that they had suffered a similar fate. Meanwhile, several of the young men who took part in the study indicated that they often used intimidation, deceit and alcohol as ways of coercing a woman into having sex with them. When these acts of sexual violence are considered alongside the physical violence that young women experience at the hands of their fathers, brothers and boyfriends, it should come as no surprise that most have learned to manipulate their bodies and desires in ways that are pleasing to men (for example through make-up or tight-fitting clothes).
In the face of this oppression, women often display symptoms of post-traumatic stress disorder, a learned hopelessness that makes them incapable of responding to new crises. Thus, women may become progressively more vulnerable to male aggression because of the extent to which previous trauma has eroded their capacity to halt abuse.
However, despite the level of violence, it should be noted that the gender system imposes certain costs upon its beneficiaries as well. For example, the association of alcohol with masculinity makes young men drink excessively, indeed so much so that one community leader in Villa del Mar commented that the community's men have become 'sub-male', given the degree to which machismo has made drunkenness and the dole a way of life. Moreover, this self-destructive orientation is also apparent in men's tendency to spurn bodily care or preventative health measures for fear of appearing effeminate and weak. Of course, it need hardly be added in this regard that a culture which treats half its population as objects and the other half as conquering giants will have difficulty in promoting ideas around AIDS awareness and prevention.
Economic violence
While Costa Rica's dominant discourses purport to be democratic, offering everyone equal access to their bounty so long as they adhere to certain fundamental principles, in fact they reflect the narrow interests of the country's upper and middles classes. However, despite this inequity in the distribution of resources, members of marginalized communities like Villa del Mar have been co-opted into accepting the tenets of hegemonic discourses, and in many cases have even become their most staunch defenders.
How so? On the one hand, many of the individuals whose lives have been torn apart by the effects of joblessness, violence, substance abuse and family break-up have been drawn to the redemptive power of Christianity. Thus, whether or not the Church is actually able to deliver on all of its promises, at least it offers the possibility of salvation, something which is very appealing to those who are faced with so many problems. However, as we have argued above, not only is the Church leadership opposed to birth control and premarital sex, but it has resisted strongly any attempts to discuss these issues in a serious manner.
On the other hand, gender discourses have also been influential in this regard, particularly in poor communities where they are learned and reinforced on the street. That is to say, not only are women given fewer opportunities to become self-sufficient by their parents (eg. in terms of education or a vocation), but the dominant gender system is such that their earning power is far less than that of men in any case. Of course, these obstacles contribute in turn to a situation in which women lack the resources to empower themselves, and thus have little choice but to engage in activities which serve to perpetuate the existing gender order.
Escapism and unrealistic solutions
Escapism is yet another means by which young people attempt to deal with the proliferation of conflicting discourses. Substance abuse, music and dancing are all examples of escapist activities. However, not only do they risk becoming addictive, but many are co-factors in HIV infections as well.
Although there are many reasons why young people might abuse drugs or alcohol, a number of issues stand out as particularly significant in this regard. In the first instance, they provide a useful means of overcoming inhibitions, allowing men to express emotions normally considered 'feminine', and women to become more aggressive and assertive (a finding noted by the project ethnographer following visits to the countryside outside of Villa del Mar). Of course, drugs and alcohol also offer young people a way of escaping from problems of everyday life, whether these involve contradictory messages sent to them by their parents, the effects of divorce, or grinding physical and sexual abuse.
Toward an alternative model for prevention
At present, the dominant health promotion discourse in Costa Rica is that of the bio-medical model. Within this paradigm, experts seek to prevent disease by devising education and information campaigns based upon the most recent technological advances. Moreover, this is the model that has been used by Costa Rican state actors in the fight against HIV/AIDS.
Without wishing to suggest that all segments of the health promotion community, let alone all segments of society at large, support its underlying premises, it is nonetheless possible to summarize them as follows:
Have these hypotheses and policies produced the desired results? We believe that the findings of our study, outlined in previous chapters, have adequately answered this question.
Quite simply, our research has shown that reproductive health education per se does not necessarily contribute to young people's health because there is no attempt to grapple with the larger socio-cultural context. That is to say, despite the fact that 80 percent of the country's population in 1990 reported knowing how to protect itself from HIV infection, only 25 percent of sexually active males and 16 percent of sexually active females made regular use of condoms (Madrigal and Schifter 1990). Thus, the problem is not so much a lack of scientific information, but rather the social relations and structures which serve to perpetuate high risk behavior on the part of youth.
As such, the 'rational choice' which health experts have promoted (ie. have sex only when married) is not necessarily appropriate in light of the social realities faced by the bulk of Costa Rica's adolescent population. For example, if one considers the conditions under which young women in Villa del Mar live, one will soon realize that interventions designed simply to encourage sexual abstinence are deeply flawed. Why is the case? In short, for these women, pregnancy offers them the hope of establishing a bond with a man, who will then take them away from an oppressive existence in their parents' home. Having no job prospects in any case, they have nothing to lose and everything to gain.
Furthermore, we already know that the years six to 12 are critical in a child's sexual development. It is a time when gender differences become pronounced, and adulthood beckons for many living in poor communities throughout the Third World. Thus, for these individuals, the concept of adolescence means little, and is seen merely as a middle class luxury to be enjoyed by youth who need not get married at an early age or work to support their families. As such, we believe it is critical that sex education be provided at an earlier age than is currently the case, so as to maximize AIDS awareness among what is already a vulnerable segment of the population.
Furthermore, after analyzing the content of sex education classes as they are now provided in Costa Rican schools, we would argue that the latter reinforces existing gender stereotypes. In short, while girls tend to be provided with more information on pregnancy, boys receive more detailed information on sexually-transmitted diseases. In this way, the ‘scientific’ discourses of reproductive health promote sexism by placing the responsibility for pregnancy on women and STD control on men. Moreover, further exacerbating this sexism is the fact the sex education teachers tend to pay more attention to boys in class, and answer their questions ahead of those of girls.
To summarize, one might argue that the single-minded use of a bio-medical approach in sex education has not served the cause of AIDS prevention particularly well, for a number of reasons. Firstly, its emphasis upon biology to the exclusion of emotions and pleasure serves to make young people skeptical of the messages received, since they do not believe the course is dealing with the subject in an honest fashion. Additionally, the approach reinforces gender biases while ignoring the degree of variability in students' socio-economic background, both of which conspire in turn to alienate youth, and to make them that much more likely to compartmentalize their thoughts and actions in ways that place them at heightened risk of HIV infection.
Discourse analysis as prevention
The in-depth interviews we carried out in Villa del Mar and Villa del Sol affected the young participants in ways that we had not anticipated. Foremost in this regard was the fact that young people became sensitized to the contradictory nature of the messages they were receiving, and that these messages influenced their behaviour. In gaining awareness in this way, they reported to us that they felt in greater control of their lives. This result came as a surprise to us because our interviewers had only asked questions; no advice or counsel was given.
Based on these responses, we decided that our proposed model for AIDS prevention should have youth empowerment as its primary objective. As a means of accomplishing this goal, young people will be asked to analyze prevailing sexual discourses and cultures themselves, focusing on the latter's contradictions and the forms of resistance these engender.
Moreover, by placing youth at the forefront of the discussion, the programme's content will focus on AIDS-related issues in terms that are relevant and meaningful to the participants involved, with prospective topics including internal and external censorship, compartmentalization, magic-religious thought, and economic and physical violence. We believe that the principal problem currently facing young people is not so much the contradictory nature of dominant discourses, but rather the lack of freedom to question them. As such, our approach to AIDS prevention will seek to inculcate critical thinking in areas touching upon sex and sexuality.
Moreover, our findings have also led us to identify the following recommendations:
1. Make prevention culture-specific
Strategy: Different messages, different interventions
That messages around issues of sexuality are contradictory is generally acknowledged. Responsibility for this state of confusion is deemed to lie either with the media, for disseminating suggestive or pornographic messages, or the Church, for its refusal to countenance a pragmatic approach towards family planning and STD prevention. According to Lilian, owner of Villa del Mar's pool hall, youth are confused “because at school they talk to them about sex, but without spirituality ... they are only told about condoms and the pill.” On the other hand, Gerber, the school counselor, maintains that the Catholic Church is responsible for not giving young people the necessary information on condoms and family planning methods. Moreover, on those occasions when he has broached the topic of birth control, parents petition the Church to have him silenced. However, despite their disagreements, both Lilian and Gerber believe that discourses on sexuality should speak with one voice. As Lilian put it, 'the family, the school, the press, television ... we all should be able to agree on one view and give only one message.”
Of course, state-sponsored AIDS education campaigns did attempt to unify the discourses by adopting a position that incorporated the Church's ideals of fidelity and abstinence before marriage, yet encouraged condom use should young people decide to become sexually active. The entire country dreamed of an all-embracing discourse that would put an end to contradiction and diversity. As such, each subsequent prevention campaign has sought to achieve consensus on the central message to be disseminated. In cases where consensus could not be reached, some other message would have to be found that would allow the parties involved to paper over their differences, even at the cost of reinforcing the view that theory and practice are two very different things.
Yet, at the same time that the country's elites were engaged in debate over the content of prevention programmes, young people have continued to have unsafe sex. Generally speaking, the age of initiation is 16 years for boys and a little older for girls; this pattern has not changed substantially over the past forty years. This fact, in combination with the responses of research participants themselves, has led us to propose a new model for prevention, which, rather than identifying a single unifying message, endeavours to incorporate inconsistency and contradiction. After all, why only have one prevention discourse when there are any number of sexual discourses in circulation, each with its own rules and values?
Among the discourses we have identified in this study are those of gender, class, sexual orientation religion and culture. For example, while homophobia is common among Costa Rican youth, rejection of homosexuality varies according to each group's understanding of sexual orientation. In one case, it may be rejected for reasons related to gender and in another because of pathological concepts associated with homosexuality. Moreover, any number of other factors are also relevant in this regard, such as social status, wealth, education and the role of institutions in the day-to-day lives of community members.
As one might imagine, the observations made above only serve to underscore the view that, if prevention initiatives are to be effective, differences in gender, class and sexual culture (inter alia) must be addressed. In short, each community must have a prevention programme that is cognizant of its particular needs and resources.
Meanwhile, all programmes (including those channeled through the mass media) should include messages on tolerance and respect for women and minority groups. Moreover, sexual minorities in particular must be targeted in all prevention efforts, for only in this way will we be able to counteract the discrimination and lack of support that these communities have traditionally faced.
Some examples of ineffective campaigns:
From the information we have gathered in our study, we are able to identify which intervention techniques are likely to fail in the targeted communities, and why.
(a) Messages targeting young women to use condoms:
A recent mass media campaign orchestrated by the Ministry of Health showed young women with condoms in their purses. However, in both of the communities where we undertook our research, sexually assertive young women are thought of as prostitutes; and thus it is unlikely that any of the young women we interviewed would identify with these role models.
(b) Workshops for men who have sex with men
A gay organization based in San José decided to undertake an initiative in Villa del Mar that sought to promote AIDS prevention among men who have sex with other men. Prior to their first meeting, they invited members from a number of groups to attend, including transvestites and cacheros. However, few people showed up, and none of these was a cachero. How to e