Think About the Choices You Make: creating a culturally appropriate sexual health promotion DVD for young Aboriginal people
Think About the Choices You Make: creating a culturally appropriate sexual health promotion DVD for young Aboriginal people
HIV Australia | Vol. 11 No. 3 | October 2013
By Laura Jenkins, Marnie Britton, Kate Green, Christine Edwards, Graham Smith, Karen Nairn and Karen Gillham
Background
Over the past decade, rates of sexually transmissible infections (STIs) have increased in Australia.1
The most frequently reported STI in both Aboriginal and non-Aboriginal young people is chlamydia,2 which often has no symptoms and can go undetected.
Gonorrhoea is also a major concern for the Aboriginal population, with rates of diagnosis over 21 times higher than in the non-Aboriginal population.3
Chlamydia and gonorrhoea are usually easily cured but if left untreated can lead to chronic pain, inflammation and infertility in both males and females.
The NSW Sexually Transmissible Infections Strategy 2006–2009 lists both Aboriginal people and young people as priority populations, on the basis of the prevalence of STIs in these groups.4
NSW has been identified as having the largest Aboriginal population of any state or territory in Australia, comprising nearly 30% of the total Indigenous population.5
In 2011–12, the internationally accredited Making Proud Choices sexual and reproductive health education package6 was adapted by Hunter New England Population Health for use in a rural community in NSW with a high percentage of Aboriginal people.
The Aboriginal sexual and reproductive health workers delivering the sessions identified the lack of a culturally specific audiovisual resource for Aboriginal young people as a gap in the youth education program.
As a result, the Think About the Choices You Make DVD was created by HNE Population Health.
About the DVD
Think About the Choices You Make is a sexual and reproductive health education DVD appropriate for use by Aboriginal health workers, youth workers, teachers and other health professionals working with young Aboriginal people.
The DVD has been approved for use by NSW Health. Although the primary target audience is Aboriginal adolescents aged 16–19 years, the DVD is also intended to educate parents, carers, community, and service providers.
The 12-minute DVD portrays how a group of Aboriginal teenagers deal with the possible consequences of unprotected sex, including STIs and unplanned pregnancy.
Key messages in the DVD include:
- the importance of wearing condoms to protect against STIs and unplanned pregnancy
- where to access sexual health help and advice
- the availability of friends and family as a sexual health support network, and
- where to access condoms.
The film centres on two teenage couples, Tahlia and Jordan, and Ashley and Dean. The story is told in a documentary style, with the characters talking directly to camera about their experiences.
These monologues are interspersed with flashback scenes that show pivotal events in the story as the characters describe them.
Development
The DVD was developed by the HNE sexual health promotion unit in collaboration with the HNE Aboriginal Sexual and Reproductive Health Advisory Group, and was produced by Red Hat Films.
To ensure the finished product was culturally sensitive and relevant, Aboriginal community members and Aboriginal health workers from the Hunter New England area had input into the script at all stages of the script’s development – first, second and final draft.
When considering the target group, the DVD was developed to be positive, fun, culturally appropriate, energetic and supportive.
Special care was taken during script development not to be patronising, clinical or judgemental. Local Aboriginal youth (15–19 years old, male and female) were invited to take part in a confidential focus group with Red Hat Films’ producer and scriptwriter.
The young people gave feedback on the first draft of the script and the proposed cast.
They also discussed young people’s attitudes to a wide variety of topics including sex, STIs, music, fashion, friendship groups and culture, as well as their use of language.
During the casting process, actors and extras were selected from the local Aboriginal community wherever possible.
An Aboriginal Community Liaison Officer assisted in recruiting local Aboriginal youth to work on the project.
The music and artwork used in the DVD was developed by Aboriginal adolescents to promote sexual and reproductive health in their community as part of the Making Proud Choices program.
Filming
While the DVD contains themes that all young people can relate to, the primary target group is young Aboriginal people.
As each character introduces themselves to the camera, they identify the Aboriginal nation they belong to.
To further enhance that cultural connection, Aboriginal-themed props were used liberally throughout the shoot; Aboriginal health promotion posters were displayed on the walls of the doctor’s office where the girls attended for an appointment, an Aboriginal flag was shown in one of the character’s bedrooms and the boys wore black, red and yellow Aboriginal wristbands.
In order for the documentary-style film to be as realistic and natural as possible, actors were encouraged to ‘ad-lib’ their dialogue, using words and phrases that they would use themselves in real life; the cast also wore their own clothes and applied their own make-up.
To give the bedroom scene added authenticity, the actors assisted the production team in decorating the room with youth-friendly posters and props before filming commenced.
To ensure that the young cast members felt comfortable and safe, two Aboriginal health workers (one male, one female) were on set at all times to provide support and advice.
The health workers also operated as cultural consultants during filming. The actors also had the opportunity to review each take they appeared in to ensure they were comfortable with the content.
Educational supplement
The DVD is accompanied by an educational supplement for the worker to use after showing the film to a young audience.
The supplement provides a summary of the key points raised in the DVD and possible questions to prompt thought and discussion around sexual health issues for young people.
The main discussion points covered by the education supplement include:
- the importance of condom use, options for contraception
- consequences of unsafe sex
- STIs not always having symptoms, and
- negotiating safer sex with a partner and sourcing sexual health support and information.
An evaluation survey is also included with the education supplement, and can be administered before the DVD is shown to ascertain the audience’s basic sexual health knowledge.
The survey can be re-administered again after the DVD viewing and subsequent discussion, to ascertain whether the audience’s basic knowledge has increased as a result of exposure to the resource.
The story
Ashley and Dean meet at a party one night and end up having unprotected sex.
Ashley then visits the doctor with her best friends Tahlia and Lisa and asks for a prescription for the contraceptive pill.
While she is there, the doctor also suggests she be tested for STIs and pregnancy because she did not use a condom during sex.
Her pregnancy test results come back negative, but she tests positive for chlamydia.
Ashley elects to tell Dean about it herself, which results in a heated argument between the two.
Dean believes that chlamydia is a ‘girl’s disease’ and that he couldn’t have passed it on to Ashley.
However, he eventually goes to the doctor for treatment and accepts responsibility as he has never used condoms during sex before.
Tahlia and Jordon see the difficult time that Ashley and Dean go through after having unprotected sex, and do not want the same thing to happen to them.
When they decide they are ready to have sex, they discuss it between themselves and also speak to trusted family members for advice.
Tahlia visits the doctor with her mother, where she is given a prescription for the contraceptive pill, and Jordon talks to his father about using protection.
As well as using the contraceptive pill, the couple ensure that they use condoms whenever they have sex.
Ashley and Tahlia also encourage their friend Lisa to take some free condoms from the clinic, just in case!
Although Lisa is not in a relationship and not ready to have sex yet, she is happy that when she is ready to take that step, her friends will be there to support her like she did for them.
The girls help and support each other through these difficult sexual health issues, without judgement of their differing views and experiences.
The boys also learn the importance of discussing sexual health together, realising that Jordan had previously been oblivious to the fact that Dean was taking risks and being unsafe.
Ashley ultimately ends up talking to her mother about her experience, and learns that her mother is a good source of support for her.
Ashley and Dean eventually make up, and ensure that they now practise safe sex all the time.
Access
The DVD can be viewed free of charge through the HNEHealth YouTube channel (www.youtube.com/user/HNEHealth). To purchase a hard copy of the DVD and educational supplement please contact the Hunter New England sexual health promotion unit on (02) 4924 6499.
Acknowledgements
The Hunter New England sexual health promotion team would like to acknowledge the following people for their valued assistance, input and guidance: Lyn Brown; Sarah Burrell-Davis; Amanda Leonard; Annette Slater; Red Hat Films; and HNE Aboriginal Sexual and Reproductive Health Advisory Group.
Laura Jenkins (Project Officer at Hunter New England Population Health), Marnie Britton (Project Officer at Hunter New England Population Health), Kate Green (Aboriginal Sexual and Reproductive Health Worker at Hunter New England Population Health), Christine Edwards (HARP Health Promotion Manager at Hunter New England Population Health), Graham Smith (Aboriginal Sexual Health Worker at Hunter New England Population Health), Karen Nairn (HARP Director, Hunter New England Population Health), Karen Gillham (Director Health Promotion, Hunter New England Population Health).
References
1 Australian Bureau of Statistics (ABS). (2012). Australian Social Trends June 2012: Sexually transmissible infection. ABS, Canberra.
2 The Kirby Institute. (2013). Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: Surveillance and Evaluation Report 2013. The Kirby Institute, University of NSW, Sydney.
3 ibid.
4 NSW Department of Health. (2006). Sexually Transmissible Infections Strategy 2006–2009. NSW Health, Sydney. Retrieved from: www0.health.nsw.gov.au
5 ABS, op. cit.
6 Jemmot, L., Jemmot, J., McCaffree, K. (1995). Making Proud Choices! A Safer-Sex Approach to HIV/STDs and Teen Pregnancy Prevention. Select Media, US. Retrieved from: www.selectmedia.org/programs/choices.html