Alarmingly high STI rates
Despite access to high-quality socialized medicine, sexual health education in secondary schools, and a cultural openness about topics related to sex and reproduction, rates of sexually transmitted infections (STIs) among Greenlandic teens are some of the highest in the circumpolar north.
In a 2009 paper, Elizabeth Rink (Montana State University) wrote that between 2003 and 2006, “Greenland reported Chlamydial rates 10 times and gonorrhea rates 100 times higher than rates reported for Denmark.”
In a study titled Inuulluataarneq, a Greenlandic Inuit word that translates to “having the good life,” Rink and colleagues from the United States, Canada, Denmark, and Greenland are trying to find out why Greenland’s STI rate remains high. The next step would then be to implement the social programs necessary to change the statistics.
Focusing on schools
“In Greenland schools they teach very classic sex education – really the nuts and bolts of reproductive health and family planning. Our approach is process-building and skill-building. Really it’s about better communication between partners in a culture that addresses conflict very differently than we do as Americans. We tend to be much more direct one-on-one,” explains Rink. “Greenlanders tend to address conflict as a collective. It’s a very different way of communicating.”
Community-Based participatory research
Rink’s community-based participatory research (CBPR) project builds on the 2007-2009 Greenland Sexual Health Study, an international effort that focused on quantifying the commonness of different STIs and the cultural factors contributing to Greenland’s high rates.
According to Rink, the CBRP approach, in which scientists and communities are equal partners in the research process, is essential to successful studies in Greenland and other locations with limited resources and where cultural, language, and geographical barriers may challenge traditional research methods.
Enlisting the locals
“Our previous study was largely exploratory. We found that there is not a perception of risk among Greenlanders related to sex. There is also a high level of trust amongst Greenlanders. We also found that in Greenland, with a CPBR approach, more people understand what we are trying to do and take ownership because the research is not being done to them but with them,” says Rink. “We are working with community advisory boards, three or four volunteer members, who input how they want the research to happen. We readjust our plan when we need to.”
Cultural differences in negotiation are historically important in Greenland and around the Arctic. After all, handling often harsh climatic conditions as a group has ensured their people’s survival.
“The biggest challenge, aside from the remoteness of field locations, is turning off the American way of looking at things. In the U.S., a woman is much more likely to require her partner to wear a condom during sex, but in Greenland, if the woman requests it, and her partner doesn’t want to, then she has created conflict, a situation with which their culture is typically uncomfortable.“ Rink says. “The cultural emphasis is not on direct communication with one’s partner. Typically, if there is perceived conflict, of any kind, between two people, someone else intervenes as mediator. They have a culture of collective decision-making on all levels at all times.”
During their three-year, U.S. National Science Foundation-funded study, Rink and colleagues have worked with about 100 teens, men and women, ages 14-19, and their parents within a community-based framework in Ittoqqortoormiit, Paamiut and Uummannaq.
In-depth surveys assess teen attitudes surrounding sex, cultural beliefs about sexual and reproductive health, and social norms regarding communication about sex. Scientists also administer urine and vaginal swab tests to check for STIs. Once the research team established baselines, teens began attending one-to-two weeks of intensive sexual education focus groups.
Topics addressed in the focus groups were designed by the youth in each of the research sites and were based on what Greenlandic youth believed to be important about how to prevent getting an STI and addressed issues such as self confidence, trust, what is a healthy relationship, communication skills, and planning a future. Survey and testing follow-ups at one month and six months will complete the study.
“We will use storytelling as part of our educational methodology. Stories are very positive and pro-social and focus on honor and being a good, strong person for family and community,” Rink explains. “The emphasis is on participants thinking about the person that they want to be and the person their community would like them to be.”—Marcy Davis