Creating Without Shame: Care Providers Turn Real-Life Stories Into an HIV-Focused Telenovela

A Conversation With Sin Vergüenza Producers and Creators Natalie Sanchez and Hilda Sandoval

Associate Editor

Family secrets ... betrayed trust ... condom usage?

The classic, persistent themes of Spanish-language soap operas, also known as telenovelas, get a refreshing, enthralling update in Sin Vergüenza (Without Shame), the new telenovela that is taking the Internet by storm. Presented in English as well as Spanish, and imagined and realized by California's vast AltaMed health care network, the aim of the show is to "educate without being educational." The project is a unique endeavor -- it combines a fresh narrative format with the ability to tackle real-world issues such as HIV, stigma, lesbian/gay/bisexual/transgender (LGBT) issues, family issues, infidelity, shame, aging, dating and more.

Before you read, make sure to watch Episode 3 of Sin Vergüenza. Stay tuned for two more episodes in the coming weeks -- each accompanied by a conversation with key people involved in the production!

Haz clic aquí para ver la telenovela Sin Vergüenza, capítulo 3, en español.

For those of you who have already become addicted to the story of the Salazar family as told in Sin Verguenza, welcome back! For those of you who are watching for the first time, make sure to watch Episode 1 and read an interview with some of the actors, and check out Episode 2 with an accompanying chat with series director Paco Farias. After watching Episode 3 of the series below, read about how it all got started! In Part Three of this series of interviews, Sin Vergüenza's creators, Natalie Sanchez (HIV prevention program manager) and Hilda Sandoval (HIV psychosocial unit program manager) of AltaMed, talked with about every aspect of the process. They discuss how they planned to make the series accessible for people of all backgrounds, and what it was like to try on the shoes of TV producers for six months.

Mathew Rodriguez: Can you give an overview of what AltaMed does and what they offer?

Natalie Sanchez and Hilda Sandoval
Hilda Sandoval (on left) and Natalie Sanchez

Natalie Sanchez: AltaMed is the largest federally qualified health center in the nation, and we offer primary health care at 22 clinics. But, altogether, we have 43 sites. We serve about 150,000 clients in a year. We have been providing HIV services for over 20 years.

Hilda Sandoval: Of the 22 sites that provide medical services, three of them focus on HIV care. Recently we implemented universal testing at all of our sites, and when a patient is identified as HIV positive, the referral is sent over to us, whether it's at East L.A., Pico Rivera or El Monte, which are the sites that have specialized care for HIV patients.

Mathew Rodriguez: Does AltaMed serve a particularly large Latino population?

Natalie Sanchez: Yes, actually, we are centralized in L.A. County and Orange County, and the focus of the care that we provide is really targeting Latinos. We have a rather large number of patients who come in who are monolingual Spanish-speaking, uninsured, and also undocumented. We really take great pride in saying that we do not discriminate -- anybody gets treated, and the same applies to our general medical sites. Because we are a federally qualified health program, we have the luxury to provide care to all individuals who come in through our doors. And a good number of them are Latino.

Hilda Sandoval: We definitely take great pride in serving those who are underrepresented in the community. So the fact that we do this work is a rewarding experience for most of our employees.

Mathew Rodriguez: What made you both want to pursue this project as part of the HIV services that AltaMed offers?

"It's taken us some time to change the culture and to prepare providers, as well as clinic staff and clients, to accept HIV as a routine part of care, because there's this perception that HIV only affects certain populations. We've had to do a lot of training." -- Natalie Sanchez

Natalie Sanchez: The primary reason that we wanted to do this telenovela series was to raise awareness about HIV and the importance of routine HIV testing. We've incorporated routine HIV testing into all 22 of our clinics. It's taken us some time to change the culture and to prepare providers, as well as clinic staff and clients, to accept HIV as a routine part of care, because there's this perception that HIV only affects certain populations. We've had to do a lot of training. But now we're looking at doing a lot more training with our clients who perceive that they're not at risk for HIV.

Hilda Sandoval: About a year and a half ago, we had the opportunity of developing a series of videos for staff, and the focus of that project was really to get AltaMed staff as a whole, not only in HIV services but everyone else, at one level of understanding some of the important components of working with our community. Natalie and I were both involved in the development and the writing of those modules. We created an HIV 101, Universal HIV Testing, Delivering a Positive Result, LGBT Cultural Sensitivity, and Linguistic Services Accessibility.

It was really a wonderful project, because we were able to connect all of the missing pieces that we have as an organization. Yes, we talk about HIV all the time, but that's the work that we do. In our general medicine departments, treating a client who's identified with an HIV diagnosis, there were times in which our medical staff didn't have the appropriate tools to address their needs. With the implementation of universal testing, it gave us the opportunity to begin that dialogue.

When we had the opportunity to have additional funding this past year, we said, "We need to do more, but now we need to connect to the community." Internally we were working to develop a better understanding on the effects of HIV on our population, but now we needed to reach those individuals in the community who do not think they are at risk. We were brainstorming on an idea. We knew we needed to educate the community, but we needed to do it in a way that was not educational. We needed to do it in a way that had some type of a story, something that was suspenseful, something that had intrigue. And that led to the telenovela.

We were at a table, just talking about this project, and we were sitting with John Reynolds, who is part of the production team that we had worked with on the first project. Natalie, John, Tom, our director [at AltaMed] and a few other individuals were there, and we were saying, "OK, what do we need to do?" We threw out a lot of ideas and Natalie said, "I'd love to see a grandmother in a story." And from there it kind of evolved: "Oh, we need a young, gay man in the story"; and "We need a closeted older gay man." It morphed into this wonderful family. I say "morphed" because each family member represents a patient that we've seen over the last 20 years. The stories, many times, overlap. Many times, we hear one story, and we say, "That sounds like So-and-so's story." Because it's a repeated story, that means it's a continuing issue, and that means we're not talking about it. That's why we found it so relevant to address in this format.

Natalie Sanchez: Another reason we said that we didn't want to do the traditional education is because people ignore it. [laughs] We've been in the field for so long, for over 10 years, and we do it on a day-to-day basis where we're educating the community, doing HIV 101, but people just don't connect. And, yes, they'll hear you, but they'll think, "Oh, that's somebody else's story. That doesn't affect me. That doesn't apply to me." By doing these storylines, we're addressing not only HIV risk, but some of the generational traditions that have been passed on.

If you look at the different generations in the series, the grandmother, the mother, and the daughter, you'll see some of the traditions that are being past on and the struggle of Christina, the young one, to kind of break out of those traditions, in dealing with her own relationship in today's generation and being able to make choices and be assertive in requesting to use a condom with her partner.

We also wanted to address different marital statuses. In our clinics, as we're doing routine HIV testing, we get a lot of comebacks where patients say, "Well, I'm not at risk for HIV, I don't think I should get at test, because I've been married for over 10 years, and I know I'm not with anybody else." So we wanted to address that by having family members who are in relationships, as well as family members who had been married, and those that are not married.

"\[T\]he stories are intended to ignite some discussions, or to hit a nerve here and there. When we start talking about these transgenerational issues, we're also taking about those family secrets, those issues of infidelity, that we all know take place, but _nobody_ wants to come to light." -- Hilda Sandoval

Hilda Sandoval: I'd like to add that the stories are intended to ignite some discussions, or to hit a nerve here and there. When we start talking about these transgenerational issues, we're also taking about those family secrets, those issues of infidelity, that we all know take place, but nobody wants to come to light. And then we brought in another layer, another big taboo, which is to talk about homosexuality. I think addressing the challenges and the stigma that still exist in our community as it relates to someone who is gay identified, or questioning, or struggling with their sexual identity, is one of those things that we don't have the tools as a community to really start talking about.

We've gotten some feedback from some viewers who said, "Wow, you normally don't see a condom being pulled out"; "You normally don't see the disapproval taking place between a father and a gay son"; "You normally don't see the issue of infidelity hit on so many levels." The daughter seeing the mom in distress because she suspects her father is being unfaithful; the daughter not knowing how to respond to her father, but putting a condom in his pocket, but, at the same time, still struggling to talk about it to him, like, "Dad, why are you doing this to mom?" And then, going back to her own relationship and saying, "There is this pattern that I want to stop." These are the things that we normally see in a very vague tone in normal novelas, but Sin Vergüenza really just pushes the envelope.

It's the elephants in the room that nobody wants to talk about, but they're constantly being shoved in their faces. And that's what HIV is: You need to talk about it.

Mathew Rodriguez: Did you sit down with the writer to write the script for the series, or did you give the writer your ideas? How does a process this huge get done?

Natalie Sanchez: It was a six-month process, and that's actually really quick for a non-profit organization to get something done in six months. [laughs] We worked with a professional scriptwriter and he did a draft based on the storylines and the characters that we came up with. We would do read-throughs of the script and go over the different lines and read them, and we'd be like, "Our clients would never say that. So let's change that." Then we would go through the script, editing. We probably did that about four to five times. I mean, I think we had about five drafts of the script. Once we had the script finalized, we worked with Kavich-Reynolds Productions to do the casting, and they did the scouting of the location. Everything after the script was done moved really quickly. A couple weeks later, we were already shooting and filming the four episodes.

Hilda Sandoval: Paco Farias was brought in by Kavich-Reynolds to be the director, and he met with Natalie and me, and loved the idea, loved the concept. He did a read-through himself and added the "Paco touch." Then we pushed on and identified the cast. That was a really neat process; and then right off the bat, the filming started.

Natalie Sanchez: When we first met with Paco, Hilda and I were like, "Tell us the truth, do you really like it? Do you like this script?" Because we loved it, and we're biased. [laughs] And he said, "Yeah," because there was so much more there than just that element of education about HIV. There were so many elements to the story that he really felt that it was a true telenovela.

Hilda Sandoval: There was such a realness to some of the experiences, some of the drama, some of the secrets; you're like, "OK, you can't make this up." And you really can't, because it's based on real life.

"There was this wonderful exchange between the reality and what normally happens on TV, and really getting viewers to see that when someone finds out that they're positive, it's a life-changing experience. We wanted to do it justice." -- Hilda Sandoval

There are some patterns, some very common themes that we've seen over the years here. Let's say, for example, after someone finding out that she's positive, that the family would be very happy and support the father at the end. They all go to the clinic together. We're like, "No, that would not happen!" [laughs] There was this wonderful exchange between the reality and what normally happens on TV, and really getting viewers to see that when someone finds out that they're positive, it's a life-changing experience. We wanted to do it justice. We didn't want to feel like we were wrapping it the story up with a bow at the end and it's perfect; because the reality is, when someone find out that they're positive, their life is changed. For the good, for the bad, whatever it is, it's changed. And we wanted to honor that.

We wanted to make sure that we told the story as it has been experienced, but also give the notion that it's not always the feeling of having to hide it. That it's important to talk about it, that it's important to address it and really start seeing that it's a problem and if we don't talk about it as a community, it will continue.

Mathew Rodriguez: Whose idea was it to offer the series in English and Spanish?

Natalie Sanchez: I think it was just all of us. We said that having subtitles at the bottom would not do the series justice. The clientele that we serve is highly Latino, and a lot of the patients speak Spanish, but we also have the second and third generation who don't speak any Spanish. We wanted to be able to reach a large Latino audience.

Hilda Sandoval: We also possibly wanted to have it in our waiting rooms. We wanted people to view it at any time they wanted, other organizations to use it as a prevention tool, to get the discussion of reducing risk behaviors going in the community. We said it had to be done in both languages to make sure that we target both audiences.

I definitely don't want to disregard the other communities we serve here. We serve the African-American community. And I think the themes that you see in this telenovela for the Latino community really hold true in the African-American community. Even though it has a Salazar name, you can put another name on it, and the themes would be honest for what you see in that community, as well.

Mathew Rodriguez: It is universal to a lot of communities of color. If you watch mainstream television, we usually only see white characters telling us "universal" stories. This series shows that you can have universal stories told by Latino characters. Anyone can definitely relate to the family dynamics and the keeping of family secrets, and all that nice stuff that families go through.

One of the things that Paco talked about was that there is such a rhythm and flow to some of the words in Spanish that is just lost in English.

"In the English version, we have that character actually saying the word 'SIDA,' because that leaves an impact in the viewers' mind, as opposed to 'I have AIDS.' But 'SIDA' is just like, wow. As a Latino, you feel that." -- Hilda Sandoval

Hilda Sandoval: Even when we were writing the script, we wondered, do we have the character who is identified as HIV positive say "SIDA" or "AIDS?" Do we have them stick to what is proper, or to what we know? In the English version, we have that character actually saying the word "SIDA," because that leaves an impact in the viewers' mind, as opposed to "I have AIDS." But "SIDA" is just like, wow. As a Latino, you feel that. We go into the explanation later of what is the difference between HIV and AIDS, and we throw in that education in that moment, but in a very subtle way. Definitely, there are still some terms that we just had to keep to the Spanish language.

Mathew Rodriguez: You both work at a nonprofit, and you both, for a few months at least, got to step into TV producer roles for a while. [laughs]

Natalie Sanchez: Yeah, it was hard to go back to our normal jobs, just let me tell you. [laughs]

Hilda Sandoval: We came back to paperwork, reports ... [laughs] As great as it was, we had to manage our departments in between. Usually, we were running into the clinic, Natalie was running into her office, and we'd say, "OK, we have to leave mid-day for the shooting or for the writing." We made it happen in six months and we don't know how!

It was a joy, for me. It was the chance of a lifetime. It was a very unique experience. The cast is immensely proud of the project that they've participated in. They feel very blessed and honored to be part of this project. They feel that it's a wonderful piece for connecting people and helping to reduce the transmission of HIV. Natalie and I have a warm and fuzzy relationship with the cast now. We're friends on Facebook, we talk on a regular basis.

Mathew Rodriguez: I'm sure you get this question all the time and you're going to get it from me, too, because I'm so addicted to the series: Are there any plans for Sin Vergüenza after it's done, if it's super successful? Would you do it again if people wanted to see more?

Hilda Sandoval: Our goal is that it gets picked up by a TV station and gets shown mainstream and reaches a larger audience outside of what we have control of, outside of our own reach. If it can get picked up, and shown as a special on a cable channel, or just a TV network, that would be our goal.

We have a storyline to carry us through at least five more episodes. We're hoping to get additional funding, to take the audience through what happens after the diagnosis. We're kind of leaving the story with someone getting their diagnosis, but the audience doesn't know what happens next, and the complex issues that come up after a diagnosis.

Mathew Rodriguez: Oh my God, I so want to know who gets diagnosed! [laughs]

Natalie Sanchez: Not even our friends and family get that information!

This transcript has been lightly edited for clarity.

Mathew Rodriguez is the editorial project manager for and

Follow Mathew on Twitter: @mathewrodriguez.