Cultural Competency.  This phrase is used all the time in the context of delivering HIV services, particularly to communities of color.  But what do we mean when we say “cultural competency”?  And what is the difference between being culturally competent, culturally sensitive, and culturally aware?  If you do a Google search, you’ll quickly find that there are many different definitions for each of these terms.

The Centers for Disease Control write “Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

For health care providers working with Asian & Pacific Islander communities, the concept of being culturally competent can be overwhelming and at times, unrealistic.  The umbrella of “Asians and Pacific Islanders” comprises more than 40 ethnic groups and over 100 languages.  The sheer diversity of this group makes it almost impossible for a health care provider to be aware of each culture, let alone competent.  

To make it easier, we can view it as a process, or a continuum, in which cultural awareness (knowledge of another cultural/ethnic group) and sensitivity (understanding of cultural differences without assigning values) are both preconditions for becoming culturally competent.  And any step we take in learning about another culture and understanding how cultural norms can affect a client’s view of health, can move us further along that continuum.  For example, the discussion of certain topics, including sex, homosexuality, drug use, and HIV, is taboo in many A&PI cultures. Providers who understand the taboos and stigma and who can bring them up in a sensitive and non-threatening manner will be able to meet critical health and social service needs.

 We also need to recognize and acknowledge our personal biases and stereotypes about unfamiliar traditions and lifestyles.  For example, many A&PI cultures employ traditional healing methods, and providers trained in ‘Western’ medical practices will need to take the time to learn about these methods and work with their clients to incorporate them into a treatment regimen.

 If we’re addressing cultural competence for A&PI populations, we must also discuss language barriers. Health information can be hard enough to understand for native English speakers, so one can imagine the difficulties of trying to learn about HIV and health issues for non-English speakers.  Furthermore, there is a serious lack of HIV prevention and treatment education materials in A&PI languages. 

 On a final note, whether or not one fully understands the concept of cultural competence, providers who are open to learning, and have a healthy curiosity and respect for their clients’ worldviews are more likely to make their clients feel safe and welcomed, and succeed in improving health outcomes.