In an effort to reduce the high rate of HIV transmission among Latino men who have sex with men (MSM) and transgender women, U.S. researchers have implemented a program aimed at successfully preventing HIV within this historically hard-to-reach population.
Among Latino and Hispanic MSM, one in four is expected to be diagnosed with HIV in his lifetime if current infection rates continue, according to estimates from the U.S. Centers for Disease Control (CDC).
In North Carolina, the Latino community represents 9% of the population, yet compared to other groups, Latinos are less likely to seek health services because of a dearth of Spanish-speaking providers and anti-immigration sentiment in the state.
The new intervention program, called HOLA en Grupos, is an effort by researchers at Wake Forest Baptist Medical Center and the CDC to close this gap.
"It's not easy going to a health department when you're Spanish speaking in the South," said principal investigator Scott D. Rhodes, Ph.D., chair of social sciences and health policy and director of the Program in Community Engagement at Wake Forest School of Medicine. "Folks are very fearful of accessing services and fearful of stepping forward."
This problem inspired Rhodes, who is a Spanish speaker, to team up with a local community organization to create a prevention training program that was based on formative research, he said. Rhodes and his colleagues sought to create a program "grounded in community priorities," and developed and implemented in Spanish.
HOLA en Grupos encompassed the "real, lived experiences of Spanish speaking Latino MSM," Rhodes said. To test its effectiveness preventing HIV infections, the researchers recruited 304 Latino MSM and transgender women from 2012 to 2015, assigning some the HOLA en Grupos intervention and others a general health education program.
After the program was over, HOLA en Grupos participants were more likely than the control group to use condoms and to get tested for HIV. Among the HOLA en Grupos participants, self-reported condom use jumped from 33% to 65%, and HIV testing increased from 32% to 80%. The control group saw very little change in behavior. The findings were published online May 12 in the American Journal of Public Health.
The Hola en Grupos participants were better educated about HIV and other STIs, the best way to use a condom safely, and how to communicate with partners. They also reported a decreased sense of fatalism.
"We had 100% retention rate, which is phenomenal," said Rhodes. "It's very difficult to get vulnerable communities enrolled in research and retained in research. Being able to follow these men and trans women for six months is amazing and highly unusual."
Rhodes and his colleagues emphasized the cultural and social aspects of the prevention program, incorporating training components that helped participants unpack the expectation that men should adopt a traditional masculine identity -- an expectation that is pervasive in Western culture broadly and in Latino culture specifically, Rhodes said.
"We really do focus on what it's like to be born male in the Latino community and the stresses that puts on people, both on men who engage in same sex behavior as well as transgender women," Rhodes said.
Rhodes expected that HOLA en Grupos would impact each participant's notion of masculinity by celebrating traditional values while also reframing some of the negative aspects. However, contrary to Rhodes' expectations, the HOLA en Grupos programming did not appear to affect participant's views on masculinity, nor did it affect ethnic pride, which was a surprise, Rhodes said.
Yet overall the findings reflect the fact that HIV prevention efforts designed with up-front community input can have a major public health impact.
Back when this study started in 2012, Rhodes said, pre-exposure prophylaxis (PrEP) wasn't really on the scene yet. But today most prevention programming includes not only condoms and HIV testing, but also PrEP.
Therefore, although the CDC has incorporated HOLA en Grupos into its compendium of evidence-based behavior interventions, the intervention itself should probably be updated to reflect PrEP, Rhodes said.
"Figuring out how to do more research and improve our practice around HIV is important, especially for Spanish-speaking populations," Rhodes said.