Eva M. Moya

Still a hard-to-reach population? Using social media to recruit latino gay couples for an HIV intervention adaptation study

Background Online social networking use has increased rapidly among African American and Latino men who have sex with men (MSM), making it important to understand how these technologies can be used to reach, retain, and maintain individuals in care and promote health wellness. In particular, the Internet is increasingly recognized as a platform for health communication and education. However, little is known about how primarily Spanish-speaking populations use and engage with each other through social media platforms. Objective We aimed to recruit eligible couples for a study to adapt “Connect ‘n Unite” (an HIV prevention intervention initially created for black gay couples) for Spanish-speaking Latino gay couples living in New York City. Methods In order to successfully design and implement an effective social media recruitment campaign to reach Spanish-speaking Latino gay couples for our ongoing “Latinos en Pareja” study, our community stakeholders and research team used McGuire’s communication/persuasion matrix. The matrix guided our research, specifically each marketing “channel”, targeted “message”, and target population or “receiver”. We developed a social media recruitment protocol and trained our research staff and stakeholders to conduct social media recruitment. Results As a result, in just 1 month, we recruited all of our subjects (N=14 couples, that is, N=28 participants) and reached more than 35,658 participants through different channels. One of the major successes of our social media recruitment campaign was to build a strong stakeholder base that became involved early on in all aspects of the research process—from pilot study writing and development to recruitment and retention. In addition, the variety of “messages” used across different social media platforms (including Facebook, the “Latinos en Pareja” study website, Craigslist, and various smartphone applications such as Grindr, SCRUFF, and Jack’d) helped recruit Latino gay couples. We also relied on a wide range of community-based organizations across New York City to promote the study and build in the social media components. Conclusions Our findings highlight the importance of incorporating communication technologies into the recruitment and engagement of participants in HIV interventions. Particularly, the success of our social media recruitment strategy with Spanish-speaking Latino MSM shows that this population is not particularly “hard to reach”, as it is often characterized within public health literature.

Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples

Introduction Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition. Materials and Methods We collaborated with Latino male couples and providers to adapt Connect ‘n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention. Results The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention. Discussion We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this population.

Policies and Laws Affecting Mexican-Origin Immigrant Access and Utilization of Substance Abuse Treatment: Obstacles to Recovery and Immigrant Health

Abstract This article reports the results of a study carried out with 30 Mexican-origin immigrants in drug user treatment in the United States-Mexico Border city of El Paso, Texas during 2007. Qualitative, semi-structured interviews were implemented to assess the dynamic social and economic factors that affect the delivery and utilization of treatment services, with emphasis on the impact of recent immigration-related laws and policies. The research provides initial data for evidence-based intervention and reinforces the need for culturally and gender appropriate treatment services for poor immigrants and their families. The studys limitations are noted.

Intimate Partner Violence and Sexual Health Voices and Images of Latina Immigrant Survivors in Southwestern United States

Intimate partner violence (IPV), which describes physical and/or sexual assault of a spouse or sexually intimate companion, is a common health care issue across the globe. However, existing health outcomes studies are limited. Additionally, no study to our knowledge has specifically focused on the relationship between IPV and sexual health among Latina immigrants in southwestern United States. Through the use of photovoice methodology and a community-based participatory research approach, we assessed these types of relationships drawing on data gathered from 22 Latina survivors of IPV and 20 community stakeholders in El Paso, Texas. Participants identified two major themes: the different expressions of domestic violence and the need for access to sexual and reproductive health services. Community stakeholders and participants identified practical and achievable recommendations and actions including the development of a promotora training program on IPV and sexual health. This assessment extends beyond HIV and STI risk behaviors and highlights disease prevention within a wellness and health promotion framework.

Social Justice in the US-Mexico Border Region

This chapter introduces the book and its conceptual framework. The US-Mexico border region is defined as a geographic, economic, cultural, and social region that is affected by systematic social and economic injustice that has resulted in the social and economic problems that are evident throughout the region, including poverty, health inequities, and low-wage assembly, service, and agricultural employment. The endemic poverty coexists with institutional racism and gender violence. The region, while populated by resilient families and communities that have long confronted governmental neglect and social isolation, is at the periphery of the American economy. A brief summary of the history of the US-Mexico border region is included. The border region is distinct in its Mexican-American majority population, its location on a semi-porous border through which people and commodities flow under the close scrutiny of a huge law enforcement presence that further marginalizes residents on each side of the border. This chapter describes the social construction of events on the border as a “moral panic” in which immigrants are caricatured and the drug war is seen in apocalyptic terms.

Adaptation of a Couple-Based HIV/STI Prevention Intervention for Latino Men Who Have Sex With Men in New York City:

Predominantly Spanish-speaking Latino men who have sex with men (MSM) and their same-sex partners continue to be at high risk for HIV and STIs. Behavioral research has identified how relationship dynamics for male couples are associated with sexual risk behavior. Connect ‘n Unite (CNU), an evidence-based HIV/STI prevention intervention originally created for Black MSM and their same-sex partners, was adapted for predominantly Spanish-speaking Latino MSM and their same-sex partners on the assumption that its key elements would be translatable while its efficacy would be retained. A systematic adaptation process utilizing qualitative methods was used, including intervention adaptation sessions with 20 predominantly Spanish-speaking Latino gay couples and 10 health service providers. The process included five steps: (1) engaging community stakeholders, (2) capturing the lived experiences of Latino gay couples, (3) identifying intervention priorities, (4) integrating the original intervention’s social cognitive theory into a relationship-oriented, ecological framework for Latino gay couples, and (5) adapting intervention activities and materials. The adapted intervention, which we called Latinos en Pareja or Latinos in a Relationship, incorporates elements that effective HIV prevention interventions share, including: a solid theoretical foundation; emphasis on increasing risk reduction norms, sexual communication skills and social support for protection; and guidance on how to utilize available, culturally and linguistically appropriate services. The systematic adaptation approach used for a couples-based HIV prevention intervention also can be employed by other researchers and community stakeholders to adapt evidence-based interventions that promote wellness, linkage to care, and disease prevention for populations not originally targeted.

Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City

Abstract Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.

Border Health: Inequities, Social Determinants, and the Cases of Tuberculosis and HIV

The US-Mexico border region attracts migrants from Mexico and Latin America who seek economic opportunities through relocation to the United States. These goals are not always achieved once they arrive in the region, thus creating populations that are displaced and vulnerable. Further, when poor people migrate into developed countries, there is an increased risk for adverse health outcomes. An example is the association between the distributions of TB and HIV with social disparities and access to medical care and treatment. The trend in public health research along the border has increased focus on an individual’s behavior while deemphasizing the social determinants of disease. This chapter includes a description of the social determinants of health and health outcomes prevalent along the border, the case of TB and HIV with appropriate or lack of structural interventions, and recommendations for policy.

In Pursuit of Safe Drinking Water in the Texas-Mexico Border Region: A Matter of Social Justice

The U.S.-Mexico border is populated by resilient families and characterized by environmental, social, economic, cultural, and epidemiologic inequalities. Person-in-environment perspectives and the need to embrace a new concept of environment to improve well-being of individuals and eradicate social conditions that undermine health are vital. One of the most innovative and promising mechanisms to improve water safety in underserved communities is the use of nanotechnology devices. The manuscript exposes the water scarcity, contamination and the health and social impacts in the Southwest border region and explores the use of Nanotechnology Enabled Water Treatment (NEWT) devices an alternative for water purification. These technologies will be portable, use less water treatment chemicals (i.e., chlorine) and electricity by employing nanophotonics for processes such as solar desalination. Nanotechnology seems to have the potential to address some of the pressing water safety and environmental needs. Caution, however, should be used when implementing nanotechnology especially when done with members of vulnerable populations. Community-engagement is crucial to inform scientists and researchers about the social needs through the use of participatory action research methods like focus groups, in-depth interviews and forums. The NEWT Project is an interdisciplinary, multi-institution nanosytems-engineering research center, consisting of an interdisciplinary research team of engineers, chemists, psychologists, social workers and community partners.

Adults Experiencing Homelessness in the US–Mexico Border Region: A Photovoice Project

Homelessness is a social, economic, and political crisis in the United States. In particular, the US–Mexico Border region has seen a surge of homelessness, specifically among veterans, women victims of intimate partner violence, and immigrants. In 2014, 12 persons in El Paso, TX, with experience of being homeless used the photovoice methodology to participate in a project titled, “The Voices and Images of the Residents of the Opportunity Center for the Homeless: A Visual Project on the Identity and Challenges Homeless Adults Face on the Border Region.” The project was led by faculty from the Department of Social Work and facilitated by graduate students from the Departments of Social Work, Sociology, and Anthropology at the University of Texas at El Paso. In partnership with the Opportunity Center for the Homeless, a community-based organization, a gallery of photographs with respective narratives was produced along with a video documentary. The participants identified four themes: broken systems, invisibility, opportunities and what works, and growth and determination. These themes represent participants’ life experiences with homelessness and their aspirations. In addition to the photo gallery, participants supported the development of a Call to Action asking the community, policy, and decision makers to commit to changing the current social, economic, and political conditions affecting individuals experiencing homelessness. The gallery, Call to Action, and overall participant experiences with photovoice were shared during local, regional, and national conferences and events, including three State of the Homeless Conferences led by the Opportunity Center for the Homeless in partnership with the university.