Treatment providers and counselors must examine two essential factors when working with
culturally, racially, or ethnically different populations: the socioeconomic status of the client or
group and the client's degree of acculturation. A distinction should be made when discussing a
population as a whole and a particular segment of that population. For example, when treating an
HIV-infected substance-abusing Hispanic woman, the counselor should focus on the woman as
an individual and on the particular circumstances of this individual's life, rather than seeing her
as an abstract representative of her culture or race. More often, poverty is the relevant issue to be
The second factor, degree of acculturation, is important and should be part of the assessment
process. How acculturated or assimilated are the family and client? What generation is this
client? Assessing for this, and knowing that several generations with different values and levels
of acculturation may all live in one household, can test the communication skills and counseling
skills of the best service providers. When discussing acculturation/ assimilation and values,
counselors should keep in mind that, in general, the more years a family has lived in the United
States, the less traditional their values tend to be. Thus a fourth-generation Chinese-American
client may not speak Chinese or hold traditional Chinese values. Knowing the values and beliefs
of a client is crucial if treatment is to be effective.
Providers must also help develop culturally competent systems of care. A part of this is making
services accessible to and often used by the target risk populations. Culturally competent systems
also recognize the importance of culture, cross-cultural relationships, cultural differences, and
Aside from assessing cultural competence using the five elements discussed previously, it also is
helpful to examine some ways in which providers can minimize cultural clashes and blocks that
may exist when working with clients. The guidelines given in Figure 7-3 are adapted from a
project conducted by the University of Hawaii AIDS Education Project.
One concern in providing culturally competent care is how to discuss values and differences
around sex and sexuality. In many cultures, people avoid discussing sex because they find such
discussions disrespectful. This is one reason why so many cultures avoid discussing
homosexuality. A counselor should consider using a less direct approach when initiating
discussion about issues related to sex and sexual orientation. Many providers believe that some
of the public health problems faced in communities of color and the gay community are related
to their inability to speak often and directly enough about safer sex practices, risky behaviors,
and homosexuality. Even in the recovery culture and in many treatment settings, sex and
sexuality are blatantly avoided. Service providers must acknowledge that they, too, in addition to
their clients, are often uncomfortable talking about sexuality, sexual identity, and sexual
orientation.
Providers also should be aware of the messages often given to communities of color and
particularly women. The message, "stop having sex," often advocated by providers has been
mixed with historical issues and fears of racial/ethnic genocide, thus making it difficult for most
