Keystone Health

Keystone Farmworker Program’s HIV prevention program has three basic components: risk behavior assessment, intervention and HIV/STD testing. All prevention activities are done in the field in labor camps or farmworker homes and are interwoven into the overall medical program. For example, the outreach worker who provides the HIV/STD services also participates in the field clinics as an interpreter. He helps with intake for the Adult Immunization Campaign and does follow-up BP readings and glucose checks. The fact that services are interwoven removes much of the stigma and provides greater access than if the organization were only an HIV service agency. Keystone’s success with working with HIV/STD prevention and other issues is also greatly influenced by the program’s cultural approach. Folk healers are an important source of health care for many of the farmworkers in their countries of origin. Without promoting any particular religion, Keystone's staff members are extremely respectful of the spiritual beliefs of the farmworker community. Few farmworkers have had the opportunity for formal education; most progressing no further than 6th grade, if having attended school at all. To provide effective health education, the Keystone Farmworker Program opts for novellas – comic book-style soap operas which provide information in a manner that is both culturally recognizable and appropriate for low level literacy. Because the most influential people in this culture are family members, staff has a familial approach to the farmworker community. All farmworkers are greeted as family, and are welcomed to labor camps in the area served by the regional office with homemade cakes and cookies. This relationship allows staff to urge farmworkers to schedule services like gynecological exams and PAP smears, get flu shots, and take HIV/STD tests in a way that would be inappropriate in Western medicine, but is totally acceptable, even welcome, in this culture. Staff uses its sincere concern for their health and well being as consistent with both the desire to represent family here in the states, and with the tenant that love heals. (Despite applying family-type pressure, a  farmworker’s decision not to participate is always respected by the staff.) Cultural competency is incomplete without an understanding of the day to day complexities of the farmworker lifestyle. Even when belief in the concept of prevention is shaky or non-existent, risk reduction can occur when linked to other non-medical consequences. Thus staff places emphasis on the financial cost of behaviors such as alcohol and drug use which also impact the ability to remember and act on risk reduction strategies. Farmworkers are reminded that missed time from work after a weekend of substance abuse binging results in a reduction of money earned and can place jobs in jeopardy. Alcohol-fueled brawls endanger friendships – a costly consequence for farmworkers trying to survive away from home with few friends – and have the potential to result in jail and/or deportation, particularly in today’s political climate. Farmworkers are reminded that the loved ones waiting for them in their country, for whom much sacrifice has been made, will also share the consequence of infection, either through becoming infected themselves and/or by being left with no one to support or care for them. In a culture where high value is placed on family, and in countries lacking social infrastructure like social security, this message is perhaps one of the most compelling.