 Foreword: HIV/AIDS Prevention in the Hispanic/Latino Community
Authors: Hazel D. Dean
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The HIV/AIDS crisis affects many communities, and Hispanics/Latinos experience a
significant portion of the burden. In 2006, Hispanics/Latinos accounted for 17% of
the estimated 56,300 new HIV infections (Hall et al, 2008). The rate of new HIV infections
among Hispanic men (43.1 per 100,000) is more than double that of white
men (19.6 per 100,000), and the rate among Hispanic women (14.4 per 100,000)
is nearly four times that of white women (3.8 per 100,000). In 2007, the rate of
new AIDS diagnoses among Hispanics/Latinos (15.2 per 100,000) was three times
as high as that among whites (5.2 per 100,000) (CDC, 2008). Although Hispanics/
Latinos comprise 14% of the US population, they account for 18% of persons living
with HIV/AIDS (CDC, 2009).
For Hispanic males living with HIV/AIDS, the most common modes for becoming
HIV-infected were sexual contact with other males, injection drug use, and highrisk
heterosexual contact. For Hispanic females living with HIV/AIDS, the most
common modes for becoming HIV-infected were high-risk heterosexual contact and
injection drug use [CDC, 2009]. HIV testing rates were slightly higher for Hispanics/
Latinos and blacks than for persons of other races or ethnicities. In a 2002 study,
50% of Hispanics aged 15-44 had ever been tested for HIV and 18% had been
tested during the past year (Anderson et al, 2005).
These numbers underscore the need to understand complex risk factors and
social determinants of health contributing to the rates of HIV/AIDS among Hispanics/
Latinos and the need to raise awareness among Hispanics/Latinos about the
effects of HIV/AIDS. Some key determinants may include structural and social factors
which may prevent access to needed HIV care and prevention services; lack of
knowledge about HIV and economic disparities which may lead to risky behaviors
further fueling increased rates of HIV and other sexually transmitted diseases; and
addressing issues related to denial, complacency and stigma which may delay HIV
testing, treatment and care. It will be important to address these determinants, as
well as others, in order to make inroads in reducing rates of HIV/AIDS among Hispanics.
Prevention efforts, such as HIV testing, remains the key element for curtailing
the spread of HIV among Hispanics/Latinos, and getting tested is the essential
first step in turning the tide. Early testing allows people who are HIV-positive to
take advantage of treatment, thereby staying healthier longer and taking steps to
protect their partners from infection. To overcome barriers to HIV testing, care and
treatment, stigma associated with HIV testing and homophobia must be addressed.
The Obama Administration announced in April 2009 a new 5-year communications
campaign, Act Against AIDS (or the Spanish language version Actúa contra
el SIDA), to refocus attention on the HIV/AIDS crisis in the United States, and to
address high rates of HIV/AIDS among certain communities and to help combat
complacency about HIV. Act Against AIDS features public service announcements,
online communications, and targeted messages and outreach to populations most
severely affected by HIV/AIDS. It will include the Hispanic/Latino community (The
White House, 2009).
HIV prevention programs must also address the needs of diverse Hispanic/
Latino communities. Prevention efforts should focus on Hispanic/Latino groups at
greatest risk - particularly, young people and men who have sex with men. Programs
must be relevant to the lives of Latino populations - appropriate to age, culture,
community standards, and language. They must be designed with input from the
Latino community and delivered by organizations and people with credibility in that
community. Through concerted efforts and commitments by all levels of society, a
reduction in the rate of HIV/AIDS can be realized in the Hispanic/Latino community.
Increases in HIV Diagnoses at the U.S.-Mexico Border, 2003-2006
Authors: Lorena Espinoza, H. Irene Hall and Xiaohong Hu
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The population at the U.S.-Mexico border has experienced growth, more than double the U.S. national average. Movements of populations in this region have contributed to increased incidence of certain infectious diseases. We used information on persons diagnosed with HIV during 2003 to 2006 and aged 13 years or older (n = 4,279) reported to the Centers for Disease Control and Prevention for 45 U.S. border counties. We estimated the annual percent change and rates with Poisson regression. Overall, 47% of persons diagnosed with HIV in the border region were Hispanic; 39% nonHispanic white; and 10% nonHispanic black. During 2003 to 2006, HIV diagnoses increased 7.8% per year. Increases were observed among males, particularly among men who have sex with men. Among females, HIV diagnoses remained stable but decreased among females in nonborder regions. The number of HIV diagnoses at the border has increased. To decrease incidence of HIV disease it is necessary to develop prevention and education programs specific to this region.
Methamphetamine and Cocaine Use among Mexican Migrants in California: The California-Mexico Epidemiological Surveillance Pilot
Authors: María Teresa Hernández, Melissa A. Sanchez, Lorena Ayala, Carlos Magis-Rodríguez, Juan D. Ruiz, Michael C. Samuel, Bart K. Aoki, Alvaro H. Garza and George F. Lemp
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Methamphetamine and cocaine use have been associated with a vulnerability to HIV infection among men who have sex with men and among men who have sex with women but not specifically among Mexican migrants in the United States. The California-Mexico Epidemiological Surveillance Pilot was a venue-based targeted survey of male and female Mexican migrants living in rural and urban areas in California. Among men (n = 985), the percentage of methamphetamine/cocaine use in the past year was 21% overall, 20% in male work venues, 19% in community venues, and 25% in high-risk behavior venues. Among women, 17% reported methamphetamine/cocaine use in high-risk behavior venues. Among men, methamphetamine/cocaine use was significantly associated with age less than 35 years, having multiple sex partners, depressive symptoms, alcohol use, sexually transmitted infections (including HIV), and higher acculturation. Prevention interventions in this population should be targeted to specific migrant sites and should address alcohol, methamphetamine, and cocaine use in the context of underlying psychosocial and environmental factors.
Drug Use and Hispanic Men Who Have Sex with Men in South Florida: Implications for Intervention Development
Authors: M. Isabel Fernández, Robin J. Jacobs, Jacob C. Warren, Jesus Sanchez and G. Stephen Bowen
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Despite continued high HIV risk among Hispanic men who have sex with men (HMSM), culturally tailored, theoretically based interventions have yet to be developed and tested. As a first step toward intervention development, we collected quantitative and qualitative data on sociocultural and psychological factors associated with drug use and risky sex among 566 HMSM recruited from community and Internet venues. Participants reported high rates of drug use (43%), unprotected anal sex (45%), and multiple sex partners (median 4) in the past 6 months. In multivariate analyses, use of drugs was associated with HIV seropositivity, less orientation to the Hispanic community, stronger attachment to the gay community, lower levels of homophobia, higher numbers of sex partners and more unprotected anal sex. The need for acceptance and desire to please partners emerged as core drivers of HIV risk in the qualitative data. Findings were used to guide development of Proyecto SOL, a theoretically grounded intervention that targets core determinants of HIV risk, builds on protective cultural influences, and strengthens positive social connections.
Familial and Cultural Influences on Sexual Risk Behaviors among Mexican, Puerto Rican, and Dominican Youth
Authors: Vincent Guilamo-Ramos, Alida Bouris, James Jaccard, Catherine Lesesne and Michelle Ballan
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The present study examined the relationship among acculturation, familismo, and HIV-related adolescent sexual risk behavior. Data were collected from Latino mother-adolescent dyads to permit parent and adolescent analyses of familismo for predicting oral, vaginal, and anal sexual behaviors. A random sample of 702 Latino eighth-grade students and their mothers was recruited from New York City. The sample included Mexicans (n = 203), Puerto Ricans (n = 239), and Dominicans (n = 260). Acculturation was unrelated to sexual behavior, but adolescent familismo was related to girls' but not boys' sexual behavior. The most important facet of familismo was subjugation to the family, which was negatively associated with girls' sexual behavior. The implications for HIV prevention programs for Latino youth are discussed.
Condom Attitudes, Perceived Vulnerability, and Sexual Risk Behaviors of Young Latino Male Urban Street Gang Members: Implications for HIV Prevention
Authors: Ronald A. Brooks, Sung-Jae Lee, Gabriel N. Stover and Thomas W. Barkley Jr.
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We examined condom attitudes, perceived vulnerability to HIV, HIV testing experiences, and sexual and substance use risk behaviors of 161 active Latino male gang members, aged 18-26 years old, living in Los Angeles, California. Gang members reported negative condom attitudes and a perceived vulnerability to HIV. The majority (53%) of gang members reported unprotected vaginal intercourse (UVI) in the previous 12 months. Multivariate analyses indicated that participants who engaged in the following behaviors were more likely to report UVI: had sex with someone they just met (adjusted odds ratio [AOR] = 3.66), received money or drugs for sex (AOR = 5.05), or had sex with someone who had a sexually transmitted disease (AOR = 4.99). Participants with a higher perceived vulnerability to HIV were less likely to report UVI (AOR = 0.82). Our findings offer implications for development of an HIV prevention intervention for Latino male gang members.
Parental Protectiveness and Unprotected Sexual Activity among Latino Adolescent Mothers and Fathers
Authors: Janna Lesser, Deborah Koniak-Griffin, Rong Huang, Sumiko Takayanagi and William G. Cumberland
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Latino pregnant and parenting adolescents living in inner cities are one of the populations at risk for acquiring HIV. Although teen parenthood has been predominantly looked at with a focus on potential adverse physical, emotional, and socioeconomic outcomes for the mother and child; a growing body of literature has documented the strengths and resiliency of young parents. Respeto/Proteger: Respecting and Protecting Our Relationships is a culturally rooted couple-focused and asset-based HIV prevention program developed for young Latino parents. In this program, parental protectiveness (defined as the parent-child emotional attachment that positively influences parental behavior) is viewed as an intrinsic and developing critical factor that supports resiliency and motivates behavioral change. The primary purpose of this article is to describe the longitudinal randomized study evaluating the effect of this intervention on unprotected vaginal sex 6 months post intervention and to determine whether parental protectiveness had a moderating effect on the intervention. The unique features of our database allow for examination of both individual and couple outcomes.
Outcomes From a Community-Based, Participatory Lay Health Adviser HIV/STD Prevention Intervention for Recently Arrived Immigrant Latino Men in Rural North Carolina
Authors: Scott D. Rhodes, Kenneth C. Hergenrather, Fred R. Bloom, Jami S. Leichliter and Jaime Montaño
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Latinos in the United States are at increased risk for HIV and sexually transmitted disease (STD) infection. We evaluated the efficacy of a pilot lay health adviser (LHA) intervention designed to increase condom use and HIV testing among Latino men. Fifteen LHAs (mean age = 35.6; range 23–60 years) from 15 Latino soccer teams were trained and worked with their teammates for 18 months. Another 15 teams served as the control group. Data were collected at baseline and at 18 months post-LHA training from a random sample of teammates from intervention and control teams. Data were collected from 222 men (mean age = 29 years) who participated in one of the 30 teams. Relative to the control condition, participants in the intervention reported more consistent condom use in the 30 days preceding follow-up (unadjusted analysis, intervention, 65.6% vs. control, 41.3%; p < .001). Participants in the intervention were more likely to report condom use (adjusted odds ratio [AOR] = 2.3; confidence interval [CI = 1.2–4.3) and HIV testing (AOR = 2.5; CI = 1.5–4.3). LHA interventions for Latino men that are developed in partnership with community members, rely on male-centered intrapersonal networks, and are culturally congruent can enhance preventive behaviors and may reduce HIV infection.
A Quasi-Experimental Evaluation of a Community-Based HIV Prevention Intervention for Mexican American Female Adolescents: The Shero's Program
Authors: Gary W. Harper, Audrey K. Bangi, Bernadette Sanchez, Mimi Doll and Ana Pedraza
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This article describes a quasi-experimental evaluation of a community-based, culturally and ecologically tailored HIV prevention intervention for Mexican American female adolescents grounded in the AIDS risk reduction model. A total of 378 Mexican American female adolescents (mean age = 15.2) participated in either the nine-session SHERO's (a female-gendered version of the word hero) intervention or a single session information-only HIV prevention intervention. Assessment data were collected at pretest, posttest, and 2-month follow up. Significant improvements across all time points were revealed on measures of self-esteem, condom attitudes, beliefs regarding a woman's control of her sexuality, beliefs regarding sexual assault, perceived peer norms, and HIV/AIDS and STI knowledge. At posttest SHERO's participants were more likely to carry condoms and to report abstaining from vaginal sex in the previous 2 months; and at 2-month follow up they reported using condoms more often in the preceding 2 months and planned on using them more frequently in the coming 2 months. Findings support the development of community-based adolescent HIV prevention interventions that address culturally specific ecological factors.
Hombres Sanos: Exposure and Response to a Social Marketing HIV Prevention Campaign Targeting Heterosexually Identified Latino Men Who Have Sex with Men and Women
Authors: Ana P. Martínez-Donate, Jennifer A. Zellner, Araceli Fernández-Cerdeño, Fernando Sañudo, Melbourne F. Hovell, Carol L. Sipan, Moshe Engelberg and Ming Ji
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This study examined the reach and impact of a social marketing intervention to reduce HIV risk among heterosexually identified (HI) Latino men who have sex with men and women (MSMW). Repeated cross-sectional intercept surveys were conducted in selected community venues during and after the campaign with 1,137 HI Latino men. Of them, 6% were classified as HI Latino MSMW. On average, 85.9% of the heterosexual respondents and 86.8% of the HI MSMW subsample reported exposure to the campaign. Responses to the campaign included having made an appointment for a male health exam that included HIV testing and using condoms. Campaign exposure was significantly associated with HIV testing behavior and intentions and with knowledge of where to get tested. The campaign reached its underserved target audience and stimulated preventive behaviors. Social marketing represents a promising approach for HIV prevention among HI Latinos, in general, and HI Latino MSMW, in particular.
The Change Approach to Capacity-Building Assistance
Authors: Miriam Y. Vega
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The CHANGE approach to capacity-building assistance (CBA), developed over 4 years by the Latino Commission on AIDS Manos Unidas' Program to assist Latino-serving community-based HIV prevention programs in eight northern U.S. states, Puerto Rico, and the U.S. Virgin Islands, is a system for providing community-based organizations (CBOs) with not only the skills to implement interventions from the Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) project, but also the capacity to reorient to the disruptive innovation of the DEBIs. The CHANGE (customized, holistic, analytical, network-building, grassroots, evaluatory) approach entails an integrated CBA-model emphasizing community and programmatic diagnosis and reflection and the enhancement of staff skills through tailored curricula in six areas: community-assessment, target-refinement, recruitment and retention, basic skills, program implementation, and evaluation. The CHANGE model encourages active CBO participation in the learning process rooted in the experiences of the organization as a member of its community.
Diffusion of Effective Behavioral Interventions and Hispanic/Latino Populations
Authors: JoAna M. Stallworth, Jonny F. Andía, Rashad Burgess, Maria E. Alvarez and Charles Collins
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The national HIV/AIDS prevention program, the Diffusion of Effective Behavioral Interventions (DEBI), is described in the context of addressing Hispanics/Latinos at risk for HIV/AIDS in the United States and Puerto Rico. The eight-step DEBI model is referenced in terms of the interventions and Division of HIV/AIDS Prevention/Capacity Building Branch (DHAP/CBB) Latino Diffusion Team activities. A summary of activities and examples addressing diffusion needs for the diverse Hispanic/Latino populations is discussed. Challenges and successes in diffusion and partner collaborations are also presented, with comment on future directions such as translations and trainings to serve the needs of the Hispanic/Latino-serving community-based organizations and their communities.
The Implementation of a Culturally based HIV Sexual Risk Reduction Program for Latino Youth in a Denver Area High School
Authors: Trisha E. Mueller, Charlene Angel Castaneda, Shannon Sainer, Donna Martinez, Jeffrey H. Herbst, Aisha L. Wilkes and Antonia M. Villarruel
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In the United States, Latino youth experience disproportionately higher rates of teen pregnancy and sexually transmitted infections (STIs) than non-Latino Whites. As a result, organizations serving Latino youth seek culturally appropriate evidence-based prevention programs that promote sexual abstinence and condom use. ¡Cuídate! is an efficacious HIV sexual risk reduction program for Latino youth aged 13–18. The program incorporates cultural beliefs that are common among Latino youth and associated with sexual risk behavior, and uses these beliefs to frame abstinence and condom use as culturally accepted and effective ways to prevent unintended pregnancy and STIs, including HIV/AIDS. ¡Cuídate! has been successfully delivered in community agencies and after-school programs but has not been integrated into an existing school curriculum. This brief case study describes efforts to implement ¡Cuídate! in a predominantly Latino urban high school in Denver. Ninety-three youth participated in the program from October 2007 to May 2008. ¡Cuídate! was adapted to accommodate the typical class period by delivering program content over a larger number of sessions and extending the total amount of time of the program to allow for additional activities. Major challenges of program implementation included student recruitment and the “opt in” policy for participation. Despite these challenges, ¡Cuídate! was implemented with minor adaptations in a school setting.
From Research to Community-Based Practice—Working with Latino Researchers to Translate and Diffuse a Culturally Relevant Evidence-Based Intervention: The Modelo de Intervención Psicomédica (MIP) Experience
Authors: Gisele Pemberton, Jonny Andía, Rafaela Robles, Charles Collins, Nelson Colón-Cartagena, Omar Pérez Del Pilar and Teresa Soto Vega
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Efforts to translate, package, and diffuse HIV/AIDS research into practice have gained momentum with the Centers for Disease Control and Prevention's (CDC's) launch of three projects: the Prevention Research Synthesis Project, which identifies evidence-based interventions studies; the Replicating Effective Programs Project, which supports the translation of evidence-based interventions into materials suitable for use in local prevention programs; and the Diffusion of Effective Behavioral Interventions Project, which moves behavioral interventions into full-scale practice across the United States. This article describes the CDC's fast-track process of translation, packaging, and diffusion of an HIV intervention for Hispanic/Latino injection drug users, the Modelo de Intervención Psicomédica conducted by the Diffusion of Effective Behavioral Interventions Project in collaboration with a CBA organization and the original researchers.
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Note: These articles were published in the AIDS Education and Prevention. Volume 21. Issue: 5 Supplement: Hispanics/Latinos and HIV/AIDS: Epidemiologic, Behavioral and Ecological Influences of Risk and Best Practices for Prevention. They have been reproduced here for education purposes only. Please visit 
