In 2021, the Biden administration renewed its commitment to ending HIV transmission within the United States by 2030. But the Biden administration will not be able to achieve this necessary goal unless they prioritize granting more resources toward developing and scaling up HIV preventive interventions tailored to Latinx folks.
Researchers have asserted that this goal is only feasible if they focus on reducing HIV stigma within Latinx communities while also developing public health interventions that are specifically targeted at Latinx folks. The Latinx community has not benefitted from increased access to HIV treatment and preventive medication in the same way that white folks have. In the U.S., 20% of people living with HIV are Latinx, and 25% of new infections occur in Latinx folks, according to the Centers for Disease Control and Prevention (CDC).
Despite this inequity in HIV transmission, there is a life-threatening lack of HIV preventive interventions designed specifically for the Latinx community. Research has primarily focused on black-white health inequities in HIV transmission, leading to less funding for programs designed specifically for the Latinx community.
Omar Martinez, J.D., M.P.H., M.S., is a leader in researching HIV prevention and treatment interventions designed specifically for the Latinx community. Martinez is an associate professor at the University of Central Florida and the director of their Implementation Science Research Lab. He has extensive experience designing and implementing culturally relevant HIV-prevention interventions for communities of color, including HoMBReS, a program for Latinx men that leverages community leaders to deliver public health advice on HIV and sexually transmitted infections (STI) testing and prevention methods; Connect ‘n’ Unite, a couples-based HIV prevention program for Black gay and bisexual men who use stimulants; and, most recently, Connecting Latinos en Pareja (CLP).
CLP is an intervention for Latinx gay couples that combines HIV prevention techniques, such as condoms and PrEP, with engagement and retention in care for those living with HIV, and developing communication skills to improve the relationship’s overall health. This program has been implemented in Philadelphia as part of a feasibility and acceptability trial, which evaluates whether a program can be successfully implemented while also reaching desired outcomes. CLP’s success in strengthening relationships and increasing use of HIV prevention methods among those who participate in the program has led to a grant submission that would expand CLP to 67 jurisdictions across the U.S.
Martinez spoke to TheBodyPro about his lifesaving work and the CLP intervention’s intent to help Latinx couples.
Alexi Chacon: I wanted to start our conversation by learning how you got involved in HIV prevention within the Latinx community.
Omar Martinez: First of all, I’m a gay Latino immigrant who came to this country in 2002, with my mother. I first lived in Miami for a year and then went to pursue my undergraduate degrees at the University of Florida, where I completed a dual degree in political science and sociology with a minor certificate in Latin American Studies. At the University of Florida, I was part of the McNair Scholars Program, which supports Black and Brown students interested in research. Through that program, I started working on HIV prevention and care for sexual and gender minorities along with Latinos and Latinas. As a gay Latino, I have lived firsthand the impact of these systems and structures on Latinx health, which is why I decided to pursue this important line of work.
Chacon: Could you give me an overview of your intervention Connecting Latinos en Pareja (CLP)? What gaps in resources are you trying to fill with this intervention?
Martinez: CLP is an intervention that is by and for sexual minority Latinos. We went through a process of developing activities and exercises for this intervention with Latino male couples. It is a project driven by and informed by members of this group. The main goal of this status-neutral intervention is to improve HIV prevention outcomes for those who are negative and improve HIV care continuum outcomes for those living with HIV. We want to improve engagement and retention in HIV care and reach viral suppression for those who are living with HIV. This is a couples-based intervention that involves two members of the dyad.
Session One walks through personal, cultural, and contextual influences on risk and protections in couples. Session Two is about communication skills and the prevention toolkit. The toolkit goes beyond condom use and presents alternatives that we now have out there, all with the idea of promoting hot, fun, and safe sex. This is key to this intervention. We’re moving away from the risk framework and developing an intervention that promotes prevention and care for this population. Session Three is about relationship strengthening as a form of HIV protection. This looks at communications within the dyad and how to improve communication among Latinx male couples. Session Four is about social support for HIV protection.
Chacon: As you were describing the intervention, you mentioned the importance of a community advisory board (CAB) in order to ensure that the intervention itself is culturally relevant. What were some instances where the community advisory board improved the intervention to be more relevant to its community?
Martinez: The CAB of 20 members informed all the stages of the research process. We had a total of 10 CAB meetings that helped inform the intervention and contributed to the dissemination of our findings. One of the key contributions was related to the messaging and communication of the intervention. The CAB wanted to make sure that we didn’t mention HIV risk at all in flyers and recruitment materials. They wanted us to emphasize that this was a community-based HIV prevention. They wanted to highlight that this is a status-neutral intervention and is not only for those who are negative but is also for people living with HIV. All of this feedback is now embedded in our communication and recruitment materials.
Additionally, the CAB was very against the idea that “sex sells” and the hyper-sexualization of Black and Brown bodies. We’ve seen a lot of that in research, where you see shirtless Black and Brown folks promoting an HIV prevention study or pharmaceutical studies. The CAB did not want to contribute to the hyper-sexualization of Black and Brown bodies. So, as a result, everyone in our recruitment materials is fully clothed and representing the wide diversity of Latino male couples.
Chacon: That’s a big pivot from the type of materials that I’ve often seen with Black and Brown bodies. Can you tell me how feasible you think this intervention is in cities outside of Philadelphia?
Martinez: We’ve just finished testing the feasibility and acceptability of the intervention and found a substantial increase in relationship strengthening among the couples randomized to the CLP program. We just actually submitted a proposal to the NIH [National Institutes of Health] to test the efficacy of this intervention, and we’re planning to roll it out in 67 jurisdictions across the country.
Chacon: What have been the outcomes of the intervention so far? And can you also define for our readers what efficacy is and how that differs from what you’ve been currently measuring?
Martinez: We just finished the feasibility and acceptability trial, which looks into whether the intervention is feasible and able to retain Latinx male couples in a study. We look into whether it is acceptable; meaning, do we see any behavioral change as a result of the intervention, and we did see changes in behaviors.
The next logical step, after a feasibility and acceptability trial, is an efficacy trial. In an efficacy trial, researchers conduct a larger-power study to test whether the intervention is efficacious in improving a particular outcome. And the outcome of interest in this efficacy trial is the promotion of HIV protection within the dyad. That means increase of condom use, increase of PrEP use, and reaching viral suppression among those who are not virally suppressed and living with HIV.
It’s important to know that the efficacy trial is a power study. So we’re going to be able to engage a large number of Latinx male couples in 67 jurisdictions. We are increasing the sample size of those who could potentially benefit from this intervention.
Chacon: It’s exciting to see the pathway of an intervention being conceptualized, piloted, and scaled up. How are you connecting with other academics, community stakeholders, and policymakers to make sure that this research goes beyond being an academic citation and actually translates into community programs that are sustainably funded and operated?
Martinez: Studies usually stay on the shelf and do not get replicated because we fail with dissemination. What we’re doing is engaging with community members, interventionists, and providers that could potentially, in the future, deliver this intervention. We are also meaningfully engaging the Philadelphia Department of Health (PDH). Throughout the course of this study for years, we’ve shared our data with PDH to make sure that they were understanding the trends that we were finding, as well as to recognize the promise of this intervention. So, moving forward, we plan to do the same. That ongoing engagement of community members and folks at PDH helps build buy-in for potential implementers such as community health workers and service managers.